2025 Youth Summer Program Application

2025 Youth Summer Program Participation Application

Personal Information

Thank you for your interest in the Mindset Kidz Summer Youth Program. Please complete this application thoroughly to ensure your submission is considered for participation.

Name *

First

Last

Preferred Name:

Gender Identity: *

Male
Female
Other

Date of Birth: *

T-shirt Size? *

Phone Number *

Email Address *

Confirm Email

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Demographics

School Name: *

Current Grade: *

What’s the easiest subject for you? *

What’s the most challenging subject for you? *

Activities & Interests

School Activities You’re Involved In: *

Community or Volunteer Activities You’re Involved In: *

What motivates you to join the Mindset Kidz’s program this summer? What outcomes or experiences are you hoping to gain from participating? *

Work Interests: Please rank the following areas of work from 1 to 14, with 1 being the most interesting to you and 14 being the least:

Barbershop/Cosmetology *

Childcare *

Education *

Human Services *

Parks and Recreation *

Food Services/Cooking *

Legal Services *

Construction *

Entertainment *

Law Enforcement *

Mechanics *

Physical Fitness *

Health Care *

Property Management *

Parent/Guardian Information

Parent/Guardian Name: *

First

Last

Relationship to You: *

Phone Number: *

Email Address: *

Signature *

Clear Signature

Today's Date *