2026-2027 8GL Application

8th Grade Leaders Club 2026-2027

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

Other
School Name
Will your student be in 8th grade for the 2026–2027 school year?
Which Summit Area YMCA location will you call 'home'?
Student Ethnic Origin
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
Format: 000-000-0000.
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
Format: 000-000-0000.
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
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

8th Grade Leaders Club 2026-2027