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Welcome!

 

Thank you for your interest in joining the Rising Up Together Youth Program in Midvale! We're excited to welcome 25 youth participants in this FREE 10-Week Program. We will let all applicants know by August 30th if they have been selected to participate.

 

While spots are limited, we hope to expand the program to accommodate more youth participants in the future.

1. Participation Information

Participant Full Name:

Date of Birth:

Gender:

Grade Level:

School Name:

Participant Email:

2. Contact Information

Parent/Guardian Name(s):

Parent/Guardian Phone Number(s):

Parent/Guardian Email Address:

Address

3. Emergency Contact Information

Emergency Contact Full Name:

Emergency Contact Phone Number:

Relationship to Youth:

4. Interest and Enthusiasm

Which of the following activities are you most excited about? (Check all that apply)

Check all that apply:

Is there any type of activity you would rather not participate in? (Please explain why)

What is something new you would like to learn or try in this program? (Select all that apply)

Check all that apply:

What do you hope to achieve or gain from participating in the Rising Up Together program?

How excited are you to join the Rising Up Together Youth Program? (Rate on a 1 to 5 scale 1 = Not excited, 5 = Very excited)

5. Participation

The participant can meet every Monday at 4 to 6 pm at the Midvale Youth Center?

Yes or No

If not, what dates would they miss?

The participant is dedicated to having fun, making friends, and building resilience.

Yes or No

Do you know anyone else participating in the program?

Multiple Choice

If you were to share this program with your friends, how would you most likely share it?

Multiple Choice

Food often makes every activity more fun. Do you have any food allergies or sensitivities? If so, explain?

6. Additional Information

Is there any information you would like the program staff to know about your youth?

Would you be interested in learning more about and joining our Youth Council?

Multiple Choice

Rising Up Together Youth Program Application Questions

Welcome!

 

Thank you for your interest in joining the Rising Up Together Youth Program in Midvale! We're excited to welcome 25 youth participants in this FREE 10-Week Program. We will let all applicants know by August 30th if they have been selected to participate.

 

While spots are limited, we hope to expand the program to accommodate more youth participants in the future.

1. Participation Information

Participant Full Name:

Date of Birth:

Gender:

Grade Level:

School Name:

Participant Email:

2. Contact Information

Parent/Guardian Name(s):

Parent/Guardian Phone Number(s):

Parent/Guardian Email Address:

Address

3. Emergency Contact Information

Emergency Contact Full Name:

Emergency Contact Phone Number:

Relationship to Youth:

4. Interest and Enthusiasm

Which of the following activities are you most excited about? (Check all that apply)

Check all that apply:

Is there any type of activity you would rather not participate in? (Please explain why)

What is something new you would like to learn or try in this program? (Select all that apply)

Check all that apply:

What do you hope to achieve or gain from participating in the Rising Up Together program?

How excited are you to join the Rising Up Together Youth Program? (Rate on a 1 to 5 scale 1 = Not excited, 5 = Very excited)

5. Participation

The participant can meet every Monday at 4 to 6 pm at the Midvale Youth Center?

Yes or No

If not, what dates would they miss?

The participant is dedicated to having fun, making friends, and building resilience.

Yes or No

Do you know anyone else participating in the program?

Multiple Choice

If you were to share this program with your friends, how would you most likely share it?

Multiple Choice

Food often makes every activity more fun. Do you have any food allergies or sensitivities? If so, explain?

6. Additional Information

Is there any information you would like the program staff to know about your youth?

Would you be interested in learning more about and joining our Youth Council?

Multiple Choice
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