Student Information Update Student Name * First Name Last Name Student Date of Birth * MM DD YYYY Student School Name * Student Grade Level * Choose a Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Student Cell Phone Please enter your phone number. If you don't have a cell phone, then leave this field blank. (###) ### #### Student Email * Student Address Address 1 Address 2 City State/Province Zip/Postal Code Country Parent/Legal Guardian Name We will send your parent a text and/or email to get their consent for you to be able to attend UYC. First Name Last Name Parent/Legal Guardian Cell Phone (###) ### #### Parent/Legal Guardian Email I agree to abide by all of the UYC's policies and any future revisions thereof. I understand that I may be removed from the UYC if I violate any policy or at the staff's discretion. * Read the full policy at https://urbanayouth.center/policy I agree Thank you for completing the membership application! Your membership will be complete once we receive consent from your parent/ legal guardian.
