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Programs
Workforce Development & Education
WayneLinc
Scholarship Program
Youth Leadership Program
Digital Literacy Courses
Government Civility & Leadership Academy
Public Health
Healthy Living
Infant & Maternal Health
Programs for Families
Programs for Adults
Programs for Youth
ACT Drug Free Community Coalition
Substance Use Prevention
Behavioral Health
Developmental Disabilities & Autism Services
Mental Health Services
Human Services
Resources
About Us
Blog
Annual Reports
Who We Serve
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Our Roots
Our Family
CEO Corner
Board of Directors
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Youth Leadership- Bridge to College Program Summer 2024
Youth Leadership-Bridge to College Program Application:
Name
*
First
Last
Email
*
Enter Email
Confirm Email
School
*
Grade Level
*
Ethnicity
*
(Arab American, African American, White, Asian, Hispanic....)
Phone
*
Address
*
Street Address
Address Line 2
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How do you feel this program will benefit you?
*
How did you learn about this program?
*
(LAHC Staff, Website, Flyer...)
Will you be able to attend all sessions?
*
Yes
No
Did you participate in this program before?
*
Yes
No
If yes, when?
Have you ever volunteered with the LAHC?
*
Yes
No
If you answered yes to the question above, please explain when and what was the program/event? If your answered No, type N/A
*
This section is to be filled by Parent/Legal Guardian
Consent
I agree
This section to be filled by parents or legal guardian ONLY if participant is under the age of 18.!
Registration Agreement: I, the undersigned, hereby authorize my (son, daughter) whose name listed above, to participate in the LAHC- Leaders Advancing and Helping Communities' Youth Leadership-Bridge to College Program. I also give him/her permission to participate in any field trips such as College Campus Tour and/or any outside visits pertaining directly to the fulfillment of the program. In enrolling at LAHC- Leaders Advancing and Helping Communities, participant understands that he/she is attending the program and using LAHC- Leaders Advancing and Helping Communities and the facilities does so at his/her own risk. LAHC- Leaders Advancing and Helping Communities and its owners, employees, board of directors or agents, shall not be liable for any damage whatsoever arising from any personal injury or property loss sustained by participant with his/her family in or about any programs on the premises. Participants and parents assume full responsibility for all injuries and damages which occur in or about any programs on the premises, He/She does hereby fully and forever release discharged hold harmless LAHC- Leaders Advancing and Helping Communities, all associated facilities and its owner, employees, board of directors and agents from any and all claims, demands, damages or rights of action, present or future resulting from any person’s participation in any programs or use of the facility. In addition, he/she agree(s) to follow the rules of conduct and play set by LAHC- Leaders Advancing and Helping Communities. Failure to do so may result in suspension from participation. Consent: I the undersigned parent or guardian/participant do hereby grant authority to the staff at LAHC- Leaders Advancing and Helping Communities to render a judgement concerning medical assistance or hospital care in the event of an accident or illness during my absence. I do hereby authorize LAHC- Leaders Advancing and Helping Communities and its assigns to utilize any and all photographs, pictures or other likeness of me or anyone assigned guardianship to me, as they deem appropriate in its promotional materials or team films.
By entering your name below, you consent to sign the application and give your approval.
Please fill in all the fields below.
Name of Parent/Legal Guardian
*
First
Last
Relationship to Student
*
Phone Number of the Parent/Guardian
*
Email of Parent/Guardian
*
Enter Email
Confirm Email