YBS Kids Membership Form

YBS Kids Membership Application

Young, Black and Suburban Kids membership is open to students in grades 6–12 who live or attend school and live in Plano, Collin County, or nearby communities. We welcome young people from all socioeconomic backgrounds who are ready to learn, connect, and grow. Complete the required fields below to begin your membership application.
Enter Member’s Information

Kindly enter the right information about the student
Member's Name

First NameLast Name
Mailing Address

Street Address Line 2

CityState

Zip Code
Member's email address
example@example.com
Member's phone number
Format: (000) 000-0000.
School District
Current Grade
Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Emergency Contact Name

First NameLast Name
Emergency phone number
Format: (000) 000-0000.
T-shirt Size
We would like to thank them!
Referred by a YBS Kids Member?
We would like to thank them!
How do you hear about YBS Kids
If yes, please type first and last name
Referred By
Please tell us what your child may be interested in learning more about.
REQUIRED PARENT/GUARDIAN AGREEMENT

Read the YBS Kids Parent/Guardian Participation Agreement
MEDIA AUTHORIZATION

Please select one. A selection is required, but permission is optional.
Use of Participant’s first name with approved media:
I understand that declining media authorization will not affect the Participant’s eligibility for membership or participation in the program.
Parent/Guardian Name

First NameLast Name
Parent/Guardian's e-mail
example@example.com
Cell Phone
Format: (000) 000-0000.
ELECTRONIC SIGNATURE

By signing below, I confirm that the information I provided is accurate and that I intend my electronic signature to serve as my legal signature.
ELECTRONIC SIGNATURE

By signing below, I confirm that the information I provided is accurate and that I intend my electronic signature to serve as my legal signature.
Signature
Enrollment
prevnext( X )
1-year membership
The 1-year membership fee helps pay for the cost of essential services, including program resources and liability insurance.

$75.00

Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

YBS Kids Membership Application

Enter Member’s Information

REQUIRED PARENT/GUARDIAN AGREEMENT

MEDIA AUTHORIZATION

ELECTRONIC SIGNATURE

Enrollment

Payment Methods