YSTLC 2022 Application form

YSTLC 2022 Student Application Form
Student Name*

First NameMiddle NameLast Name
Student Birth Date*

MonthDayYear
Student Gender
Student E-mail*
example@example.com
Student Mobile Number*
Student School*
Student Grade*
Parent Name *

First NameMiddle NameLast Name
Parent KSEA ID number (ex. 12345)
Parent E-mail*
example@example.com
Parent Mobile Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
COVID-19 vaccination is required for in-person attendance. Have you been vaccinated at least the 2nd dose? *

YesNo

Application fee*

A non-refundable $300 depositA non-refundable $300 deposit is due at the time of registration

$300.00

Total

$0.00

YSTLC 2022 Student Application Form