Summer Trips 2026

Youth's Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Date of Birth
MM slash DD slash YYYY
School*
Grade*
Parent or Guardian Name*
First Last
Parent/Guardian Cell Phone
Email*
Consent*
I hereby give my permission for my child to attend the following REACH CYA Summer Trips:
7-10-26: Tiki Park
7-23-26 Splish Splash
7-27-26 Dave and Busters

I understand:

* The program will be supervised by REACH CYA staff.
*REACH CYA does not provide any health/hospitalization insurance for my child.
*In the event you cannot be reached in a medical emergency, you give REACH CYA staff authorization to secure proper medical treatment, including taking your above named child to the nearest hospital.
*You release REACH CYA staff, Board of Directors, designated drivers and all funding sources from any liability or legal action.