LA Youth Empowered Support (YES) : Our Programs : Bent County Community Center

Test

Youth Name

First Name *

Last Name *

Address

Country

Address Line 1

City

State/Province

Postal Code

Cell Phone Number (Required)

Your Email (Required)

Parent/Guardian Name

First Name *

Last Name *

Parent Cell Number (Required)

Your Shirt Size (Required)

Do you have any allergies?

Please list allergies here

Why are you interested in serving as a youth advisor? (Required)

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In your words what does being a leader mean? (Required)

What would you like to improve and/or impact in Las Animas? (Required)

Why is it important to improve our community? (Required)

Please read this waiver of liability. (Required)

WAIVER OF LIABILITY

Our Programs