2025 Arizona Youth Impact Program for Girls Registration

In addition to the registration form below, please download the Arizona Youth Impact Program Waiver Forms after registration. You can email completed forms to ArizonaYIP@gmail.com or bring them in person to the draft night.

2025 ARIZONA YIP REGISTRATION FORM FOR GIRLS

Please use this form to register for the 2025 Girls Arizona Youth Impact Program at the University of Arizona

YOUTH INFORMATION

First Name of Youth Participant(Required)

Last Name of Youth Participant(Required)

Nickname of Youth Participant

Gender(Required)

Male

Female

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address City ZIP Code

State(Required)

Date of Birth(Required)

Grade Level as of Fall 2025(Required)

School(Required)

School District(Required)

Does the Youth Participant have knowledge of STEM?(Required)

Yes

Please describe familiarity or interaction with STEM(Required)

Height(Required)

Weight (in lbs)(Required)

T-Shirt Size(Required)

Shorts Size(Required)

Does your child have any medical/physical conditions?(Required)

Is your child currently on medication?(Required)

Does your child have any allergies?(Required)

Please list all medical conditions, allergies and medications(Required)

If none, please write none or n/a

Parent Guardian Information

Name of Parent or Guardian(Required)

Relationship to student(Required)

Cell Phone Number(Required)

Email(Required)

Enter Email Confirm Email

Secondary Contact information

If we cannot reach you, who should we call for emergencies?

Name(Required)

Relationship to Student(Required)

Cell Phone Number(Required)

Statement of Responsibility:

I, the Legal Guardian, understand that in completing this application, I support my child in participating in this academic and athletic program(Required)

I will not schedule vacation time or admit my child into other camps during the program dates, otherwise I forfeit their spot as to allow another camper to attend(Required)

I assume FULL risk and responsibility for their commitment and participation in this program and I agree to waive any claims against the YIP and the Host Organization(Required)

Entering Parent/Guardian name here authorizes legal representation for youth participation(Required)

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