Youth Summer Service Week
June 19-23, 2017 
June 26-30, 2017
Please note that tuition is due with the application.  
Acceptance into YSSW is not guaranteed until tuition has been received.
Payment can be made online. 
After completing the form you will be directed to the online payment page.
 
Questions? adrienne@thevolunteercenter.org 
 
 
Your Email:
 *
Student First Name
 *
Student Last Name:
 *
Gender
 *
Student's Cell:
 *
Student's Home #:
 
Parent/Guardian Full Name:
 *
Parent's Email:
 *
Parent's Cell:
 *
Parent Work #:
 *
Parent/Guardian Full Name:
 
Parent Email:
 
Parent Cell:
 
Parent Work#:
 
Mailing Address:
 *
City:
 *
State:
 *
Zip:
 *
School Name:
 *
County of School Attending 2016-2017:
 *
Food Restrictions
 
Allergies (list all)
 
Medical Conditions:
 
Preferred Hospital:
 
Age as of June 19, 2017
 *
How did you hear about YSSW:
 *
Check the desired week:
June 19-23
June 26-30
Both Weeks
Verification Code:
Insert above code:
 * Required


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