• YOUTH EMPOWERMENT PROJECT Application 2018 - 2019

    STUDENT SECTION ONLY
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  • What are five words that BEST describe you?

  • YEP APPLICATION 2018

    PARENT SECTION ONLY
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  • PLEASE LIST ANY MEDICAL CONDTIONS

  • Pick the best time for an interview :

  • PERMISSON TO TREAT & TRASNPORT STUDENT
    I do hereby state that I am the parent/guardian of the child named on this form. In order to expedite care of this child, I hereby give permission for the responding emergency team to
    immediately initiate treatment and transport of this child to the preferred or appropriate medical facility, according to what they deem is indicated by the nature or extent of the injuries. I also request that I be notified of my child’s condition and admission as soon as possible. If I am unable to be reached, I request the admitting facility notify one of the emergency contacts listed above about my child’s condition and admission. I agree to be financially responsible for this child’s treatment and transport. I will notify YEP of any changes to this information in writing. 

  • PHOTO RELEASE
    I hereby allow Youth Empowerment Project, Inc (YEP) to photograph my child solely for the purposes
    of promotion and advertisement.

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  • Should be Empty:
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