Please fill the application below to participate in our summer program. After you submit, you will receive an email with program instructions and information.

Name

First Name

Last Name

Email

Non-school email

City

School

Grade

Student Phone Number

Parent Name

Parent Email

Parent Phone Number

By selecting "I Agree" below, I indicate that I am committed to attend all program days and times. If for any reason, I cannot attendI must call the Adelante Youth Alliance office at 626-798-1538 and either speak with a staff member or leave a voicemail. Two (2) No Show, No Calls will result in removal from the program. Reinstatement is possible and will require a meeting with AYA staff. I also agree that disruptive behavior will not be tolerated.

I/We understand that as part of our child’s participation in AYA’s program, photos, videos, electronic images, audio recordings and quotations of my daughter/son may be taken for use in publications and reports about the program. I/We grant permission for AYA to use such materials of the program.

Adelante Youth Alliance

805 N. Madison Ave. Pasadena, CA 91104(626) 798-1538adelante@adelanteya.org

805 N. Madison Ave.
Pasadena, CA 91104
(626) 798-1538
adelante@adelanteya.org