2025-2026 8GL Application

8th Grade Leaders Club

The program application must be completed by a parent/guardian.
STUDENT INFORMATION
Student Name*

First NameLast Name
Student Date of Birth*

MonthDayYear
Student Email*
example@example.com
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Gender*

FemaleMaleOther
School Name*
Will your student be entering 8th grade for the 2025–2026 school year?*

YesNo
Which Summit Area YMCA location will you call 'home'?*

Summit YMCABerkeley Heights YMCA
Student Ethnic Origin*

American Indian/Alaska NativeAsianBlack/African AmericanNative Hawaiian/Pacific IslanderWhiteTwo or More RacesPrefer not to say
Please note: Y-USA requests the above information from YMCA participants throughout the nation for program funding and demographic purposes.
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Relationship to Student*
Parent/Guardian Date of Birth*

MonthDayYear
Parent/Guardian Phone Number*
Parent/Guardian Email*
example@example.com
Address (If different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMERGENCY CONTACT INFORMATION
Do you want to provide Emergency Contact information for the student that is different from the Parent/Guardian information provided above?*
Name

First NameLast Name
Relationship to Student
Phone Number
Address (If different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Code of Conduct Agreement*
Waiver & Release of Liability*
Please confirm you are not a robot*
Student Signature

Clear
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

8th Grade Leaders Club