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Hyde Square Task Force
Transforming Youth, Transforming Community | Transformando los Jóvenes, Transformando la Comunidad
Jóvenes en Acción Application
Art Discipline Selection
If you were to rank your preferred art discipline, which would be your first choice?
*
DANCE
MUSIC
THEATRE
If you were to rank your preferred art discipline, which would be your second choice?
*
DANCE
MUSIC
THEATRE
If you were to rank your preferred art discipline, which would be your third choice?
*
DANCE
MUSIC
THEATRE
Participant Information
Name:
*
First
Last
Date of Birth:
*
MM
DD
YYYY
Age:
*
Gender:
*
Male
Female
Other
Address:
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Home Phone Number:
*
Cell Phone Number:
*
Email Address:
*
Race (Check all that apply):
*
Black
White
Latino
Asian
Other
Ethnicity:
*
Country of Birth:
*
What school do you currently attend?
*
What grade are you in?
*
Parent / Guardian Information
Parent / Guardian Name:
*
First
Last
Relationship to youth:
*
Address:
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Home Phone Number:
*
Cell Phone Number:
*
Email Address:
*
Parent / Guardian Country of Birth:
*
Consent
*
The information provided on this form is true and accurate to the best of my knowledge and I give permission for my son/daughter to participate in Hyde Square Task Force programs and activities.
You have my consent
Parent/Guardian Signature:
*
Participant Signature:
*
Date
*
Hyde Square Task Force
Youth Community Development Center
30 Sunnyside Street, Jamaica Plain, MA 02130
(Behind the Blessed Sacrament Church Building)
Mailing Address
Hyde Square Task Force
PO Box 301871
Jamaica Plain, MA 02130