Participant Registration Form 2

SUMMER 2023 PARTICIPANT REGISTRATION

Please note the following:

This is for YC PARTICIPANTS who have a physical disability.

DEADLINE: Forms are due Friday, MAY 19.

ALL participants are required to have a medical form on file prior to attending programs. If you already completed one and there are no changes, you do NOT need to complete another one.

***If your address, phone number, or emergency contact has changed, please be sure to let Mackenzie know. ***

This is NOT your official schedule. Youth Challenge will send e-mail confirmation of the calendar once your selections have been reviewed AFTER the deadline.

TRANSPORTATION: YC is able to provide transportation for most programs. There is an option to provide detailed transportation information (such as alternative address or specific instruction for staff/drivers).

**Please complete the ENTIRE registration form and click “submit” at the end. For REGISTRATION QUESTIONS, contact:
Mackenzie Vecchio, Director of Program Services, at [email protected] or (440) 892-1001 x 18.

PARTICIPANT INFORMATION

Participant last name: *

Participant first name: *

Participant age: *

Primary contact name: *

Primary contact CELL phone number: *

Primary contact email: *

Emergency Contact Name: *

Emergency Contact CELL phone: *

Has anything changed from your most recent YC medical form submission? *
Yes
No

PROGRAM SIGN-UP

Instructions
Programs are listed chronologically by weekday. Please pay close attention to location and age restrictions. Check the programs you wish to attend. Then, check your transportation preferences and add any transportation details you wish to share.

MONDAY

MINI CAMP - AGES 4-10
Open to participants with ages 4-10. Program time is 11-2pm at various locations listed below. Join us for some sports, games, art, swimming & more! Round-trip transportation provided.
6/12 @ Avon Pool
6/19 @ Acacia Reservation, Beachwood
6/26 @ Avon Pool
7/10 @ Shaker Lakes Nature Center
7/17 @ Avon Pool
7/24 @ Upper Edgewater, Cleveland
7/31 @ Avon Pool

TUESDAY - ALL

TUESDAY PROGRAMS
Open to ALL participants ages 8-18. Program time is 11am-3pm at various locations listed below. Round-trip transportation provided.
6/13 OUTDOOR EXPLORATION @ Ohio & Erie Canal Reservation, Cleveland
6/20 KAYAK & CYCLE @ Wallace Lake, Berea
6/27 OUTDOOR ADVENTURE @ Cuyahoga Valley National Park
7/11 KAYAK & CYCLE @ Wallace Lake, Berea
7/18 TRASH TO TREASURE @ Upper Edgewater, Cleveland
7/25 ART & ARCHERY ACTIVITIES @ Sycamore Shelter, Fairview Park
8/1 VIDEO & BOARD GAMES IRL @ Highland Heights Community Park

WEDNESDAY

RUN 'N ROLL - ALL
Open to ALL participants. Program time 9-10am @ Clague Park, Westlake. YC will bring a variety of handcycles and tandem cycles for participants to utilize. Must provide OWN transportation.
6/14
6/21
6/28
7/5
7/12
7/19
7/26

SPORTS & SWIM - WEST & LC
Open to west side and Lorain County participants ages 8-18. Program time 10am-2:30pm @ Clague Park, Westlake. Enjoy a morning of sports and games followed by an afternoon of splashing around in a fabulous pool with friends. Round-trip transportation provided.
6/14
6/21
6/28
7/5
7/12
7/19
7/26
8/2

FRIDAY

SPORTS & SWIM - EAST
Open to east side participants ages 8-18. Program time 10:30am-2:30pm. Enjoy a morning of sports and games at Horseshoe Lake Park followed by an afternoon of splashing around at Thornton Pool. Round-trip transportation provided.
6/16
6/23
6/30
7/14
7/21
7/28

SPECIAL EVENTS & WEEKENDS

RACE DAY - ALL
Open to all participants, families, and friends! Join YC at the Zoo for our annual Race Day event to support YC. Program is 8-10:30am at the Cleveland Metroparks Zoo. Guests receive tickets to the zoo for the day to stay and enjoy the sights and sounds of the zoo. Must provide own transportation.
6/17

OVERNIGHT
Open to participants ages 10-18. Participants and volunteers will meet at YC at 12pm on Friday, June 7th. From there, YC will hit the road for a variety of adventures (locations TBD) and then come back to YC in the evening for a slumber party. Participants and volunteers need to be picked up from YC on Saturday, July 8th at 10am. This is a party you won't want to miss!
7/7 - 7/8
7/7 only, prefer not to sleep at YC overnight

ADAPTED SKATEBOARDING - ALL
Open to all AMBULATORY participants ages 6-18. Program time is 10-11:30am @ Lakewood Park. Join YC in learning to ride a skateboard from some professionals in the Cleveland area. Round-trip transportation provided.
7/29

SUMMERS END BASH - ALL
Open to all participants ages 4-25. Program time is 6-9pm @ YC. Join us for a big party to end the summer in YC style! Must provide own transportation. Family and friends encouraged to join.
8/5

WEEKDAY TRANSPORTATION

Weekday transportation options, check ONE:
Would like YC to provide round-trip transportation
Will provide own transportation
Would like YC to provide one-way transportation TO program
Would like YC to provide one-way transportation HOME AFTER program

Transportation details: Please provide any specific information we may need when providing transportation.

YELP

YELP TRANSPORTATION

YELP Transportation options, check ONE:
Will provide own transportation
Request YC round-trip transportation if available

DEMOGRAPHICS

Please Note
This section is not required and information provided will not be shared. Information will not impact the participant’s eligibility for programming. YC receives substantial funding from Foundations and Community Partners. Often, they require certain demographic and income data to ensure that their grantees meet requirement set forth in specific funding guidelines. If you are comfortable doing so, please complete the following section.

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