Test – The Yunion, Inc

2026 Level Up Workforce Summer Camp Registration

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Student Information

Child Name*

First Last

If you have more than one child, each child must be registered separately.

Age*

Please enter a number from 13 to 16.

Date of Birth*

MM slash DD slash YYYY

Grade Level this Fall?*

School/District*

Name of School*

Education Type*

Regular Education

IEP

504

Other

Does your Child need any additional support? Please specify in comment box below.*

Height*

Weight*

Sex*

Male

Female

Eye Color*

Brown

Green

Blue

Hazel

Ethnicity*

African American

White

Hispanic

Asian

Other

Student Address*

Street Address City State Zip Code

County in Which Child Resides*

Wayne County

Oakland County

Macomb County

Washtenaw County

Other

Parents/Guardian the Student Has (Check All That Apply)*

Mother

Father

Step-Mother

Step-Father

Guardian

Who Does the Student Live With? (Check All That Apply)*

Mother

Father

Step-Mother

Step-Father

Other

Who Does the Student Live With?*

Number of Siblings in the Home*

Are siblings applying to a Yunion camp?

Yes, they are applying for the Keys Performing Arts Camp.

Yes, they are applying for the Level Up Workforce & Leadership Development Camp.

No, they are not applying for a Yunion Camp.

List name of youth applying for Yunion Camps

Primary Language Other Than English

Are you applying for a scholarship?*

Yes, I desire a discounted camp cost if I qualify

No, I will pay the full price

Parent/Guardian Information

Name of Parent/Guardian Completing This Form*

First Last

Email Address of Parent/Guardian Completing This Form*

Your Preferred Method Of Communication*

Text

Phone Call

Cell Phone Number of Parent/Guardian Completing This Form*

Father's Information

Father/Legal Guardian*

First Last

Father's Address*

Street Address City State ZIP Code

Father's DOB

MM slash DD slash YYYY

Father's Home Number

Father's Work Number

Father's Mobile Number*

Father's Email*

Authorized to pick up?*

Yes

Mother's Information

Mother/Legal Guardian*

First Last

Mother's Address*

Street Address City State ZIP Code

Mother's DOB

MM slash DD slash YYYY

Mothers Home Number

Mothers Work Number

Mothers Mobile Number*

Mother's Email*

Authorized to pick up?*

Yes

Step-Father's Information

Step-Father*

First Last

Step-Father's Address

Street Address Address Line 2 City State ZIP Code

Step-Father's Mobile Number

Step-Father's Email

Authorized to pick up?

Yes

Step-Mother's Information

Step-Mother*

First Last

Step-Mother's Address

Street Address Address Line 2 City State ZIP Code

Authorized to pick up?

Yes

You are doing great!

Click next to continue.

Parent/Guardian Observation & Support Questionnaire

Purpose: This information helps our team better understand your child’s strengths, needs, and goals so we can support them through Yunion programs. Your responses are confidential and help us provide the best possible experience for your child.

1. Your Child’s Strengths

What are some strengths you see in your child? (Check all that apply)

Leadership potential

Creativity

Athletic ability

Compassion for others

Determination

Curiosity / enjoys learning

Strong personality / confidence

Good sense of humor

Helpful at home

Other strengths

Other strengths:

2. Areas Where Your Child May Need Support

Many young people experience challenges as they grow. Please check any areas where your child may benefit from additional guidance or support. Following Directions / Respecting Authority (Check all that apply)

Sometimes struggles to follow instructions at home

Sometimes struggles to follow instructions at school

Becomes frustrated or upset when corrected

Other

Other areas where support may be needed

Emotional Regulation / Anger (Check all that apply)

Has difficulty controlling anger or frustration

Reacts strongly to conflict or correction

Sometimes shuts down or withdraws when upset

Other

Conflict with Others (Check all that apply)

Has frequent arguments with siblings, peers, or adults

Has been involved in bullying (either as the aggressor or target)

Sometimes responds physically when upset

Other

School Engagement (Check all that apply)

Struggles with school attendance

Struggles to stay focused in class

Has experienced disciplinary action at school

Has received school suspension(s)

Other

Curfew / Home Expectations

Sometimes struggles to follow curfew or home rules

Leaving Home Without Permission (Check all that apply)

Has stayed away from home longer than expected without permission

Has run away from home

Other

Exposure to Risk Behaviors (Check all that apply)

Has been exposed to drug or alcohol use among peers

Has experimented with vaping, tobacco, alcohol, or drugs

Other

3. School Status

Has your child ever (Check all that apply):

Been suspended from school

Been expelled from school

Been transferred due to disciplinary issues

4. Social & Emotional Development (Check all that apply)

How would you describe your child most of the time?

Calm and easygoing

Energetic / high activity level

Sensitive / emotional

Independent

Strong-willed

Quiet or reserved

5. Parent Goals for Their Child

What are you hoping your child gains from LevelUp Workforce Development (Check all that apply)

More discipline

Greater respect for authority

Better anger management

Increased confidence

Positive male mentorship

Leadership skills

Stronger faith or spiritual foundation

Better decision making

Academic motivation

Other

Other goals

6. Parent Insight

What concerns you most about your child right now?

What kind of future do you hope for your child?

Preferred Hospital for Emergency Treatment

Medical Conditions (check all that apply)

None

Allergies

Asthma

Diabetes

Hearing Impairment

Heart Condition

Physical Limitation

Seizures

Vision Impairment

Requires Epi-Pen

Food Allergies

Allergic to Bees?

Yes

If medication must be administered during program hours, a medication authorization form must be on file. Parent Initials:

Additional medical or behavioral information staff should know:

Emergency Contact

Name*

Phone Number*

Additional Phone Number

Relationship to Student*

Authorized for pick up?*

Yes

Name

Phone Number

Additional Phone Number

Relationship to Student

Authorized for pick up?

Yes

Name

Phone Number

Additional Phone Number

Relationship to Student

Authorized for pick up?

Yes

Program Permisions

Emergency Medical Treatment*

By checking this box, I authorize program staff to secure emergency medical treatment for my child if needed.

Family Handbook*

By checking this box,I acknowledge receipt of the Family Handbook and agree to program policies.

Field Trips*

By checking this box, I give permission for my child to attend program field trips.

Topical Applications*

By checking this box, I give permission for sunscreen, insect repellent, and basic wound care when needed.

Attendance Expectations*

By checking this box, I understand that enrollment in this program is voluntary and regular attendance is expected for program success.

DATA & MEDIA CONSENT

I understand that The Yunion may collect program data (surveys, attendance, evaluation) to improve youth outcomes and comply with grant reporting requirements.*

By checking this box, I grant permission for photos or video of my child to be used for program promotion.

Additional Support Services

The Yunion offers optional wraparound support services to help strengthen the overall well-being of youth and families participating in our programs. When appropriate, families may be connected to additional resources such as academic tutoring, mentoring, counseling referrals, life-skills development, and parent support workshops. These services are designed to remove barriers, support positive youth development, and ensure that students and families have access to the support they need to succeed.

Would you like additional information about our support services for your child?

Tutoring (school year only)

Mentoring

Counseling referral

Behavioral support

Family resources

Not needed at this time

May one of our team members contact you with more information about our support services?

Yes

If yes:

The Yunion

Family Insight Form

Scholarship Application Section

Do you participate in the free lunch program at your school?*

Yes

No, we don't qualify

No, my school doesn't have that program

What is the annual income of your family?*

How many dependents are in your family?*

Are you a single-income family?**

Yes

Does the child for whom you are applying receive child support?**

Yes

Please explain any extenuating circumstances related to your financial need? (100 words or less)

Congratulations!

Great news! Your child qualifies for a scholarship and has been awarded a discount for this year's camp! IMPORTANT: Please complete the rest of this Registration Form as soon as possible as scholarships are limited and go fast. A completed registration is the only way to retain your scholarship. You will see your discount factored into the total cost of the camp on the last page. Congratulations!

Referral Information

How did you find out about The Yunion's Summer Camp?*

Someone referred me

Summer Discovery

Google Search

Facebook

Instagram

YouTube

Other

Name of Person/Recruiter Who Referred You*

Camp Policies & Consent Statements

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Hidden Total for Conditional Logic

Program Participation Consent*

By checking this box, I am electronically signing my application and fully agree with and understand the below consent statement.

I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. My consent for my child and or myself to participate in this program is completely voluntary. I understand that by signing this agreement, I agree to save and hold harmless and indemnify The Yunion Inc to the extent permitted by the law from all liability, loss, cost claim or damage whatsoever which may be imposed upon or incurred by said parties because of the participation of the minor in the program and release said parties in this regard on behalf of both the minor and the parents or legal guardians as well. I also grant permission for the use of images and the voice of the student and or parent while the student and or parent is involved in program activities, for promotion of The Yunion Inc., whether produced by The Yunion Inc. or commercial media outlets. I agree that my child or myself may take part in data collection methods (surveys, questionnaires, etc.) that will assist the program in determining if my child or myself was satisfied with services and if set expectations and outcomes of the program were met. Further, I understand that Yunion programming is provided at low or no cost through grantor agencies such as the Michigan Department of Health and Human Services, Wayne County Health, Human and Veteran Services, the Michigan Council for Arts and Cultural Affairs, and other private and foundation funding. My child's participation in the program may be funded through one or several of these funding sources. I also verify that all the information I have provided in filling out this form true to the best of my knowledge, and acknowledge that checking the box serves as my electronic signature.

Parent Orientation & Training Day Policy*

I agree to the Parent Training Day policy.

In order for students to receive a scholarship, it is mandatory for all parents to attend the Parent Training & Orientation. You will not only receive vital information about camp, but will be educated on the current trends in mass media that affects youth today through our "Parental Advisory" Training. Upon completion of the training, your child will receive the scholarship award letter. IMPORTANT: Please note: failure to attend will result in the revoking of the scholarship, and the balance of the original camp price of $600 will be owed. PLEASE NOTE: This year's DATE and TIME for the Parent Open House & Training Day is publicly available on the LevelUp Workforce & Leadership Development Website at https://theyunion.org/workforce-development-camp/. In addition, at some point after you register, you will receive a reminder email containing the details regarding this mandatory parent Open House & Training Day.

Refund & Cancellation Policy*

I agree to the refund & cancellation policy.

Refunds will be processed up to June 17, 2026. Due to the significantly reduced cost of the camp, please note that once camp begins, we cannot process refunds or deductions if students are absent for any reason. There will be no exceptions to this policy.

Key Camp Daily Attendance*

By checking this box, I acknowledge that daily attendance is necessary to maintain my child's scholarship in good standing.

I understand that scholarships are limited and that by accepting a scholarship and failing to ensure my child's daily attendance, I may be depriving another deserving youth of the opportunity. I agree to ensure my child's consistent attendance throughout the duration of the camp to uphold the integrity of the scholarship program.

Parent/Guardian Name (Printed)

Add Your Signature Here (Please Sign Legibly)*

Use your mouse, finger or stylus to sign your signature in the box provided below. Do your best. It does not need to be perfect.

Child's Name (Printed)

Have Your Child Sign His/Her Signature Here (Please Sign Legibly)*

Use your mouse, finger or stylus to sign your signature in the box provided below. Do your best. It does not need to be perfect.

Complete Your Registration

2026 LevelUp Workforce & Leadership Development Camp

Final Total Due Today

Total

Your total balance due today is ZERO. Congratulations on your receipt of a FULL scholarship for your child to attend Keys 2 Life Camp at absolutely no cost. To finalize your registration and retain your full scholarship, press the COMPLETE REGISTRATION button below as soon as possible.

Please Enter Your Credit Card Information*

Card Details

Cardholder Name

Please verify Cardholder Name

First Last

Billing Address*

Street Address City State ZIP Code

This field is hidden when viewing the form

Date

MM slash DD slash YYYY

IMPORTANT:

Please be sure to click the COMPLETE REGISTRATION button below ONLY ONE TIME and then be patient while your registration processes. This may take up to 30-60 seconds or more depending on your internet speed. Once the registration form fully processes, you will be redirected to a confirmation page, and you will also receive an e-mail confirmation.