Middle School Student Registration

Please take a moment to fill out this application and then click the submit button. If you would like a hard copy of the application, please contact our office and we will send you one.

Please select which seminar you would like to attend:

Oakley
NW Kansas Educational Service Center
September 16
Early Registration Deadline: Sept 2



 

 
Liberal
Seward County Community College
September 30
Early Registration Deadline: Sept 16

Iola
Allen County Community College
October 15
Early Registration Deadline: Oct 1

 Hays
Sternberg Museum
October 21
Early Registration Deadline: Oct 7

 Lawrence
University of Kansas
January 20, 2009
Early Registration Deadline: Jan 9

 Hutchinson
Hutchinson Community College
January 27, 2009
Early Registration Deadline: Jan 13

 		     
     
     
     
     

Participants Information:

School Attending
Grade
Name (First, Middle, Last)
Parents Names
Mailing Address
City
State
Zip Code
Phone Number
E-mail address
Special Needs
Hometown Newspaper
Emergency Contact Should Parents not be Available:
Name (First, Middle, Last)
Address
City
Street
Zip Code
Phone Number
T-Shirt Size: (Adult Sizes S-XXL)

How did you hear about KYLA?

 

Payment Options: Please select your method of payment from the list below.
(Please send $25/student and $15/Advisor, if applicable)

Direct Bill: Direct Bill District Direct Bill School

Check: Make checks payable to Kansas Youth Leadership Academy
........Please mail check to: KYLA, 600 Park St. Hays, KS 67601

Credit Card: (Please contact us by phone if paying with a credit card.)


Transportation:
Which vehicle will you use to bring your students (for parking/traffic reasons)
School Bus School Suburban/Van School Car/Personal Car

 


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POLICIES AND PROCEDURES

SEMINAR PAYMENTS

All payments for the Academy Seminars are within 30 days after the seminar, in which you participated. A service charge of 1.5% per month will be applied to all past due accounts.

WEATHER

The Academy has scheduled back-up-dates for each of the seminars that are held during a period in which bad weather occurs. If bad weather should arise on the day of the seminar conducted, we will have cancellations and announcements posted on our voice mail: 785.628.5399, the front page of our website: www.developingleaders.org, and a phone call and e-mail will be sent to the individual(s) who registered for the seminar.

CANCELLATIONS

All cancellations must be received in writing no later than the deadline date for the seminar that you and/or your students are attending. Cancellations will not be accepted after that date and NO refund will be given.

SPECIAL NEEDS:

It is the responsibility of parents/guardians or sponsors to bring any special physical, medical, or behavioral needs to the attention of the director on the application form of the programs the child is participating in. This information will assist us in providing a positive experience for your child.
____________________________________________________________________

You will receive a confirmation packet within 10 days of submitting information. Please contact the office if you have not heard from us within that time frame.



For any questions concerning this form or KYLA please contact:
KYLA
600 Park Street
Hays, KS 67601
(785) 628 5399
KYLA@fhsu.edu

Thanks for Registering!
 
l




"Fortunately for the world, young people are not
easily discouraged."
-Dwight D. Eisenhower

 
Kansas Youth Leadership Academy, Center for Civic Leadership, 600 Park Street, Hays, KS 67601 • Tel 785-628-5399 • Fax 785-628-4051• Email kyla@fhsu.edu
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