401 Mall Blvd. Suite 202C Savannah GA 31406 Office: 912.351.3622 Fax: 912.354.4742

YMCA of Coastal Georgia Achievers Program Application / Registration Form

401 Mall Blvd. Suite 202C Savannah GA 31406 Office: 912.351.3622 Fax: 912.354.4742

YMCA of Coastal Georgia

2017-2018 Teen Achievers Application Checklist

The following checklist will help you gather all the supporting documents required to submit a complete YMCA Achievers packet. The YMCA of Coastal Georgia Teen Achievers program looks forward to serving you.

Please Include the Following:

Application Form

Most current Unofficial Transcript (9th grade applicants must submit a transcript from their 8th grade year.)

Application Deadline: August 18, 2017

• All YMCA Achievers applications must be post marked on or prior to August 18, 2017.

• YMCA Achievers are selected based on academic achievement, motivation for learning, and commitment.

• An enrollment selection will be made no later than August 25, 2017.

• 30 YMCA Achievers applicants will be selected.

• Once selected, Achievers must pay a $50 one time annual registration fee.

Mail completed application packets to:

YMCA of Coastal Georgia Inc.

401 Mall Blvd.

Savannah, GA 31406

Attn: Audrey Rodriguez

Youth Development Director

(912) 351.3622

Please Print Clearly One Time Annual Registration Fee: $50

Name______

First M.I Last

Age (as of Sept 2017) ______Birth Date____/___/____ Race______Sex: M F

Address ______

City______State______Zip______

Student’s Email______@ ______

Home Phone ______Student’s Cell ______

School______Grade Level (for 2017-2018) ______Grade Point Average_____

Career Preference______School Counselor______

College, Tech College, or University of Choice______

Intended Major or Technical College Degree______

Parent/Guardian Name______

First M.I Last

Work Phone______Cell______

Parent/Guardian Email ______

YMCA Family Member: Yes No Military Family: Yes No

As a YMCA Achiever member, I agree to abide by the rules set forth by the YMCA. As a parent, I understand my child will be participating in activities which will provide career building strategies that focus on education, life skills, and social activities.

I am aware that my child must obey rules set forth by the YMCA of Coastal Georgia or he/she will be terminated from further participation in the program. I realize that injuries may occur; however the YMCA of Coastal Georgia does not provide supplemental accidental insurance. I agree to allow the YMCA of Coastal Georgia and its agents to secure proper medical treatment if necessary, and I will be responsible for any and all incurred expenses. I understand that some activities require transportation to and from the events.

Parent/Guardian ______Date______

YMCA Achievers Participant ______Date______

Participating Branch: ______

Is this your first year in YMCA Achievers? Yes No

**PLEASE COMPLETE THE FOLLLOWING QUESTIONS WITH AS MUCH DETAIL AS POSSIBLE**

What would you say are your biggest struggles in school and outside of school? ______

Are you involved in any after school sports or clubs? Yes No

If yes, please list name of clubs or activities that you are involved in: ______

Describe days and times these activities take place: ______

Why are you interested in the YMCA Achievers Program? ______

What is your dream job career which you are aspiring for? ______

How can the YMCA Achievers Program benefit you? What can you take away from this program?

______

What professionals would you like to hear speak at our cluster meetings from the following career fields? (circle all that apply) Military Business Social Studies Medical Arts Law Engineering Veterinary Science Cosmetology Sciences Education

Other: ______

What ideas do you have for fun activities during YMCA Achievers meetings? (e.g., dance, bowling, theater workshops, movies, indoor rock climbing) ______

PARENTS/ACHIEVER AGREEMENT

The YMCA Achievers College and Carrer Readiness Program is a program fully committed to its members. All efforts are aimed at providing a well-rounded experience that will facilitate a student’s transition from high school to college and beyond. For these reasons, we value commitment and engagement/participation from all students.

This contract is made between the Parents(s)/Guardian(s) and Student, and YMCA Achievers program for the purpose of ensuring a commitment to the attendance of YMCA Achievers events. The student and parent(s) will be provided a calendar of events during the first meeting which they can refer to. Please note that calander and activites are subject to change.

Upon signing this contract, the Parent and Student are acknowledging the maximum number of absences permitted from the part of the students to ensure continued participation in YMCA Achievers. The maximum number permitted is no more than six (6) absences in the program year. From September to December no more than two (2) absences are permitted. YMCA Achievers staff and advisors reserve the right to terminate students from program due to execive absences.

Additionally, proper conduct is expected from each Student participants. Profanity or other forms of misconduct during YMCA Achievers events will lead to the consideration of the students termination in the program.

The YMCAAchievers Program thanks you for ensuring the success of the program and that of your Student through your commitment to their education and carrer exploration.

Please sign below if you have read and agree to the above expectations

Parent/Guardian ______Date______

Teen Achievers Participant ______Date______

YMCA Mission: To put Christian principles into practice through programs that build healthy spirit, mind, and body for all.