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Afterschool Program Form
This form is for the Youth Advocacy Summit on October 16-17, 2024, sponsored by Missouri AfterSchool Network (MASN). Each afterschool program can bring up to eight youth at no charge with 1-3 staff members. MASN will cover the cost of the hotel and food and there is no registration fee. If you want to bring more than eight youth, please contact us for approval. We will charge $50 per additional child. Youth and staff will stay overnight at the Capitol Plaza Hotel in Jefferson City for an advocacy and leadership training, capitol tour and more.
Eligibility: Youth must be in grade 7-12 and enrolled in an afterschool program to participate.
There will be a virtual informational session that youth, parents and staff can attend the week prior to the summit. Following the summit, we encourage youth from your program to continue to participate on our Voice of the Youth zoom meetings, every other week on Wednesdays from 7:30-8:30 p.m. Voice of the Youth is an opportunity for youth to stay connected with other youth from the summit, and to continue to work on projects that will develop leadership and advocacy skills and support access to afterschool.
There is a separate form for youth and another for parents/ guardians to fill out. MASN will receive the completed forms but will send them to you, as well.
Afterschool program information
Afterschool program name
Program city
Name of program director
Your name
Your email
Your direct phone#
Names of youth who plan to attend. You can bring 1-8 youth in grade 7-12 (and enrolled in an afterschool program) at no charge. If you want to bring more, please contact us. There will be a $50 charge for each additional child.
Names of youth who plan to attend. You can bring 1-8 youth in grade 7-12 (and enrolled in an afterschool program) at no charge. If you want to bring more, please contact us. There will be a $50 charge for each additional child.
Name
Grade
1
1
2
2
1
2
3
1
2
4
1
2
5
1
2
6
1
2
7
1
2
8
1
2
Staff who plan to attend. We will pay for up to 3 adults to supervise the youth. They can be staff members or 1 staff and 1-2 parent/guardian. If you are bringing between 1-4 youth, you can bring 1 or 2 adults, but if you are bringing 5-6 youth, please bring 2 adults. If you are bringing 7-8 youth, please bring 3 adults.
Staff name
Staff name/ parent name
Staff name/ parent name
Are there any dietary restrictions or special accommodations needed for either staff member?
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