Polson MS - MYFS Program Sign Up

2. MYFS Program Sign Up Form (Brown MS)

4. Student Name*

5. Grade*

   1. 7
   2. 8

6. Today's Date*
   Today's Date

8. Parent/Guardian Name*

9. Parent/Guardian Cell Phone*

11. Home Address*

13. Student's Email Address*

14. Parent/Guardian Email Address*

16. Choose all programs you wish to participate in or learn more about.

    1. ROAR
    2. Girls Leadership Group

18. Photo Release*

    I give Madison Youth and Family Services premission to photograph the above named child and use any images captured on their website and/or social media pages.

    1. Yes

    1. No
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

* indicates a required field