The Depot Youth Center


2022-2023 Depot Youth Center Program WAITLIST
Contact Information
Student First Name *
Student Last Name *
Student email *
Address 1
City
State/Province
Zip
Birth Date *	// (mm/dd/yyyy)
Current Grade *
PARENT/GUARDIAN *
Parent/Guardian Cell Phone *
Parent/Guardian email
School *
Emergency Contact
Emergency Contact Phone
Demographics
We collect the following information to include in grants that go towards funding Depot programs. Your name will be kept confidential. Only your demographics will be provided. Thank you.
Ethnicity *
Family *
Free/Reduced Lunch *
Gender *
Members In Household *
Program Waitlist
Middle School Programs	6th Grade Choose Love 5th Grade Choose Love Weird Science Leadership

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