High School Registration

Dear High School,
Thank you for your interest in the 3rd Annual YES! Expo. You are helping to make this important event successful! To efficiently handle your registration, please complete sections 1-5 of this form or visit www.YEStoyouth.com to complete your registration electronically. The registration deadline is April 2, 2010.

Contact Information

Name (First, Last)
Date of Birth
Mailing Address
City, State	Zip
County
Daytime Phone Number
Email Address

Other Information

Are you a veteran or spouse of a veteran?	Yes No
Are you a current or former foster youth?	Yes No
Do you or your family recieve an of the following assistance? (select all that apply)
	WIC
	Free or reduced school lunch
	Medicaid (applicant only)
	Temporary Assistance to Needy Families (TANF)
	Supplemental Nutrition Assistance Program
	Children's Health Insurance Program (CHIP)
	Subsidized child care through Child Care Services
	Subsidized public housing
	WIA Adult Services (parent)
	None of the above