M.A.P. Application 2024

ALACHUA COUNTY

Ages 8 - 18

Today's Date

Parent's/Guardian's First name

Parent's/Guardian's Last name

Address

City/State/Zip Code

Email

Phone

Child #1

First and Last Name

Child's Age

What school does your child attend?

Is your child on free or reduced lunch?

How did you hear about us?

Child #1: What are your child's interests?

Child #1: What is your child's greatest interest?

Child #2

Child's First and Last Name

Child's Age

What school does your child attend?

Is your child on free or reduced lunch?

Child #2: What are your child's interests?

Child #2: What is your child's greatest interest?

Child #3

Child's First and Last Name

Child's Age

What school does your child attend?

Is your child on free or reduced lunch?

Child #3: What are your child's interests?

Child #3: What is your child's greatest interest?

Emergency Contacts

1. Emergency Contact First and Name

1. Emergency Contact Phone Number

2. Emergency Contact First and Last Name

2. Emergency Contact Phone Number

Parent/Guardian Consent

PARENT/GUARDIAN: I agree to receive emails and text messages about the Music & Arts Program for Youth, Inc. and can cancel anytime.

PARENT/GUIARDIAN: I agree to allow the Music & Arts Program for Youth, Inc. to photograph and video my child(ren) during program events and for use on social media for promotion and advertisement purposes.

PARENT/GUARDIAN: I agree to volunteer for one event hosted by the Music & Arts Program for Youth, Inc. during my child's/children's participation if possible.