YMLA Registration - Youth Mentoring and Discipleship Academy

Application for YMLA

Please fill out this form completely. All fields marked with * are required.

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth *

Gender *

Home Address *

Educational Background

Applicant Category *

Motivation & Commitment

How did you hear about YMLA? *

Why do you want to join YMLA? *

Are you committed to the full YMLA program requirements? *

Yes, I understand and commit to the program requirements

No, I need more information

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone *

Relationship to You *

Family/Guardian Information

Parent/Guardian Name *

Parent/Guardian Phone *

Parent/Guardian Occupation

Number of People in Household

Does your parent/guardian support your participation in YMLA? *

Yes

Health and Medical Information

Do you have any medical conditions we should be aware of?

Are you currently taking any medications?

Blood Group (if known)

Do you have any disability?

Spiritual Background

What is your religious background? *

Additional Questions

What might stop you from coming to YMLA sessions?

Is your parent or guardian aware of your application to YMLA? *

Yes

Declaration

I declare that all information provided is true and accurate to the best of my knowledge. I understand that providing false information may result in disqualification from the program.

I consent to TNGI collecting and processing my personal data for the purpose of YMLA program administration and communication.