BYA Back to School Block Party Registration Form

Parent/ Guardian Information

Please provide your name, phone number, and email address.

First Name

Last Name

Phone Number

Email

Child's Information

Please provide the name and grade for each student attending the event.
To register more than one student, click the 'Add another person' link. Students must be present to receive supplies.

First Name

Last Name

Grade

School

BYA Participant?

YesNo

Are you interested in any of BYA's programs?

Please select any program(s) you are interested in learning more about.

Afterschool CenterCareer Development CenterCounselingExtended CareHealthy LivingOutreachTeen CenterWellness

Pre-registration does not guarantee school supplies but helps us plan for attendance and create a smoother check-in experience. Please type your name below to acknowledge that you have read, understood, and agree to the statement above.

Contact Information