Official Website of St. George Youth City Council

Today is November 20, 2008

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	. :	YCC WEBMAIL

Instructions

To apply for membership in the St. George Youth City Council, COMPLETELY fill out this registration form. Print and have your parent/guardian sign the Consent and Liability Release form and mail, fax or turn in the form (information to the right).

Username & Password

Username:
Password:
Confirm Password:
Your User Name and Password are case sensitive. For security purposes, do not share your username or password with anyone.

Personal Information

Name (first, last):
Address:
City:
Zip:
Phone:	() -
E-mail Address:
Birth date:	,
Shirt Size:

Parent/Guardian Information

Primary Parent/Guardian
Full Name:
Work Phone:	() -
Mobile Phone:	() -
Relationship:

Other Parent/Guardian (if applicable)
Full Name:
Work Phone:	() -
Mobile Phone:	() -
Relationship:

Emergency Contact Information

Full Name:
Home Phone:	() -
Work Phone:	() -
Mobile Phone:	() -
Relationship:
The emergency contact is a close relative or a family friend who can quickly contact your parents and/or make emergency medical decisions for you.

Application Information

School:
Current Grade Level:
GPA:
Length of Residence:
Position Desired:
Other Positions of Interest: (Check All That Apply)	Mayor City Manager Attorney Council Member Recorder Treasurer Communications Director

Provide a Brief History of Yourself (include leadership experience, special recognition, awards, hobbies, etc.)

Why do you want to participate in YCC?

Disclaimer and Submission

I understand that by submitting this form, I am submitting an application to participate as a member of the St. George Youth City Council and that said application is only complete upon receipt of the Parental/Guardian Consent and Liability Release form and completion of an interview with the advisor. Upon completion of the application, I understand that I will be considered for membership with all other applicants and that I may or may not be selected for membership. If selected, I agree to attend all meetings and events and understand that I will be removed from membership for failure to do so. I acknowledge that while membership does not require a fee, participation in some events may require me to pay a participation fee for that event.

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A program of the St. George Leisure Services Department

For more information contact Richard Isom, Advisor at 435.688.9282 or by e-mail at

You can mail us at:
Recreation Center
Attn: Richard Isom
285 South 400 East
St. George, UT 84770

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