2021 SC YMCA Youth in Government Middle School Model Legislature Registration Form

Welcome to SC YMCA Youth in Government!

The fall conference dates are Sunday, November 7 through Wednesday, November 9. The conference is in-person. Space is limited in order to manage distancing goals.

Students are not required to be vaccinated, nor are they required to disclose vaccination status. However, students who choose not to disclose or who are not vaccinated will be asked to provide a negative PCR test from no later than 72 hours prior to the conference and take an on-site rapid test.

Please complete this form and select your intended role. for the conference. We expect roles to fill up, so your registration date and intended role will be used to assign spots.

Our Commitment to Inclusion: The Y is made up of people of all ages and from every walk of life working side by side to strengthen communities. Together we work to ensure that everyone, regardless of ability, age, cultural background, ethnicity, faith, gender, gender identity, ideology, income, national origin, race or sexual orientation has the opportunity to reach their full potential with dignity. Our core values are caring, honesty, respect and responsibility—they guide everything we do.
2021 SC YMCA Youth in Government Middle School Model Legislature Registration Form
COVID-19 vaccine status
School *
If your school is not listed contact Mary Capers Bledsoe @ mcbledsoe@ymcagreenville.org
Name *

First Name Last Name
Date of Birth *

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Student E-mail *

Confirmation Email
Student Phone Number
Grade *
Gender
Race/Ethnicity (optional)
Country of birth (optional)

This is my _______ year at the Middle School Model Legislature conference. *
Expected Role at this year's conference:

Parent/Guardian Name *

First Name Last Name
Parent/Guardian Phone Number *

Area Code Phone Number
Parent/Guardian E-mail *

Confirmation Email
Parent/Guardian Place of Employment
Second Parent/Guardian Name

First Name Last Name
Second Parent/Guardian Phone Number

Area Code Phone Number
Do you have any allergies or health conditions we should be aware of?
Should be Empty: