YAPA One Imagination S.T.E.A.M. Leadership Program

Saturdays

8:30 AM- 12:30 PM 

Grades 5th-12th 

YAPA One Imagination STEAM Leadership Program requires a per semester registration fee of $55 per participant.  Limited scholarships are available for students who can showcase need. Contact Cassandra Ernst at: cassandraernst@yapacolorado.org for more information.

Please make your payment online through the secure server "PayPal". Just click the "Donate" button and insert the statement below in the "memo" line: 

CHILD'S NAME: Fall One Imagination

Please download and review the Authorization and Waiver of a Minor Child and Field Trip Policy before filling out the application below. 

Authorization and Waiver of a Minor Child

Field Trip Policy

For questions or concerns contact Summer Murray at summermurray@yapacolorado.org or call (720) 423- 7261.

 

YAPA ENROLLMENT RECORDS
APPLICATION DATE *
APPLICATION DATE
CHILDS NAME *
CHILDS NAME
DATE OF BIRTH *
DATE OF BIRTH
Preferred Art Discipline
Please choose your top One Imagination Art Discipline. If there is more than one that interests you, you may choose up to two.
RESIDENCE *
RESIDENCE
Please list the child's most frequent or permenant address.
PARENT INFORMATION
PARENT/GUARDIAN NAME *
PARENT/GUARDIAN NAME
PARENT/GUARDIAN NAME
PARENT/GUARDIAN NAME
Please list a second parent or guardian name who is responsible for the child and has permission to pick the child up from camp.
If address is different from child's (for either parent/guardian) please list the address, city, state and zip. I.e. PARENT/GUARDIAN NAME: 555 street, city, state zip
PRIMARY CONTACT NUMBER *
PRIMARY CONTACT NUMBER
SECONDARY CONTACT NUMBER *
SECONDARY CONTACT NUMBER
Please list the name & address of parent/guardian place of employment. If parent/guardian is unemployed, please state the most likely residence you would be located during camp hours.
WORK PHONE *
WORK PHONE
EMERGENCY CONTACT
CONTACT NAME 1 *
CONTACT NAME 1
PHONE NUMBER 1 *
PHONE NUMBER 1
CONTACT NAME 2 *
CONTACT NAME 2
PHONE NUMBER 2 *
PHONE NUMBER 2
AUTHORIZATION FOR CHILD PICK-UP
Please type your full name as shown on your most current state I.D. or Drivers License as your electronic signature.
NAME OF SIBLING OR YOUNG ADULT: Authorized to pick child up from Summer Leadership.
NAME OF SIBLING OR YOUNG ADULT: Authorized to pick child up from Summer Leadership.
Other Persons authorized to pick up Child
CONTACT NAME 1
CONTACT NAME 1
PRIMARY CONTACT PHONE 1
PRIMARY CONTACT PHONE 1
CONTACT NAME 2
CONTACT NAME 2
PRIMARY CONTACT PHONE 2
PRIMARY CONTACT PHONE 2
Please type your full name as shown on your most current state I.D. or Drivers License as your electronic signature.
MEDICAL HISTORY
AUTHORIZATION FOR EMERGENCY MEDICAL CARE
Please type your full name as shown on your most current state I.D. or Drivers License as your electronic signature.
Please select an option that finishes the statement.
Doctor or Physician Name
Office Number
Office Number
Address
Address
Name of preferred hospital.
Address
Address
If applicable please list your insurance provider.
f applicable please list your insurance number.
FIELD TRIP POLICY
Please review the Field Trip Policy linked at the top of the page before consent. Type your full name as shown on your most current state I.D. or Drivers License as your electronic signature.