Summer 2020 Program Registration Form


Thank you for considering to enroll your child or children into CAN's Educational Summer Camp and/or YouthWorks programs. All Summer 2020 Programs will be conducted virtually for the safety of CAN's children, youth, families, and staff. All participants will need daily access to the Internet and a device with a camera and microphone.

Completing this form does not guarantee that your child or children are registered in our programs (due to a variety of factors including funding source restrictions, eligibility requirements, etc.).

Once this registration form is reviewed, you will receive a notification that will officially confirm your child or children have been enrolled with more program details, or an explanation as to why he, she, or they have not been enrolled.

The demographic information requested is for grant-writing purposes so we can continue to fund our free programs for children & youth.

If you have any questions, please email info@canannarbor.org or call (734) 994-2985.
Your CAN Community Center





Parent/Guardian Information
Please complete the information for yourself. If you have a partner, parent, or other adult who is a caregiver for your child/children, you may click "Add another response" to add their information, but it is not required.




Include Apartment or Unit Number separated by a comma







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Why are Race & Ethnicity broken down this way? "Race and Ethnicity" United States Census Bureau
Household Demographic Information

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Child Information
Please complete this information for your child. If you have more than one child, please select "Add another response" at the bottom of this section to add information about another child. You may add as many responses as you need to include all of the children you are registering for a program.




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YouthWorks-Specific Information
YouthWorks participants must also complete a W-9 and Work Permit per participant. Below are links to the PDF forms that you can download and print, the YouthWorks Program Director can assist with downloading and completing these PDFs, or you can find the forms in your school's administrative office.

W-9 Form

State of Michigan CA Work Permit:
CA-6 Work Permit (14-15 years) - must be printed pink, front and back
CA-7 Work Permit (16-17 years) - must be printed yellow, front and back

When these PDFs open, download them and save them to your computer or flash drive. We recommend that you print them blank and complete the paper versions. Please use the participant's information, not the parent/guardian's information when completing these forms. All forms must be completed with black ink ONLY or they will not be accepted.
Media/Photo Release
You will be asked to complete an E-Signature on the following page.
By submitting this form, you acknowledge the information in this form is accurate to the best of your knowledge.