South Shore - Marion County
Youth Leadership Program


I understand that no absence will be accepted without Advisory Board approval. I agree to conduct myself in accordance with my school's discipline policy and to follow the stated dress code policy of the South Shore - Marion County Youth Leadership Team.


______________________________________ ____________________
Parent/Guardian Date


______________________________________ ____________________
Student's Signature Date


Tuition for the program is $20.00 and is due at the first meeting in August.

Will your parent/guardian be paying for the tuition? Yes _____    No _____
Are you in need of a scholarship to pay the tuition? Yes _____    No _____


I want my name tag to read ____________________________________________.

My T-shirt size is: ___  Small ___  X Large
___  Medium ___  XX Large
___  Large

* This form may be printed from your browser. If you have been selected to participate in the South Shore - Marion County Youth Leadership Team this year, please bring this signed form (and the completed Parent/Guardian Release Form) to the Cooperative Extension Service office in the old Health office behind the nursing home in Yellville or mail it to: Renee Myers, P.O. Box 386, Yellville, AR 72687. Thank you. See you in August!

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