Youth Arise Summer 2022 Registration

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The program will be from Monday (7/18) to Friday (7/22) from 9AM to 12PM at the Guadalupe Center.
Lunch will be provided each day. Transportation is available upon request. The program will end with an overnight trip to the state capitol in Lincoln, NE to visit with state legislators and lawmakers. We will leave Scotts Bluff on Sunday (7/24) and will spend Monday (7/25) in Lincoln, coming back to Scotts Bluff on Tuesday (7/26).

Name

Email (if available)

Phone (if available)

Which school are you currently attending?

How old are you?

Please let us know if you need transportation to get to the program by checking the boxes below.

I would like to be picked up each day

I would like to be dropped off each day

I have a way to get to the program and will not need to be picked up or dropped off.

If transportation is needed, please give the address where you will need to be picked up from or dropped of at.

Will you be able to participate in the overnight trip to the State Capitol in Lincoln, NE from Sunday (7/24) - Tuesday (7/26)?

Yes, I plan on going on the trip.

No, I will not be able to go on the trip.

Maybe, I am not sure yet.

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Please list any dietary restrictions or known allergies (e.g., shellfish, peanuts, diary)

In case of an emergency, who should we contact? (Please list name and phone number)

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