Youth's Name *

First Name

Last Name

Programs (Summer and Fall)

Select all of the programs your youth is interested in participating in.

Mentorship (ages 13-18): Year-round

Tutoring: Summer

Resilience Camp: Summer (July 15-19)

Boxing Training (Requires USA Boxing Membership): Summer

Tutoring: Fall

Arts & Technology: Fall

Entrepreneurship: Fall

Legislative Affairs: Fall

Boxing Training (Requires USA Boxing Membership): Fall

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone

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