If you are interested in participating in this programming and would like to be on the youth pr parent council, please fill out the following sections and return it to us by the end of the meeting.

1. Would you like to participate in programming for children and youth? Or would you like your children or youths to participate in this programming?

2. What are the names of the children and youths, as well as their ages and gender?

3. Are you interested in participating in youth council?

4. Are parents interested in participating in the parent council?

4. What sort of programming would you like to see developed? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. What is your contact info (phone, e-mail, etc): __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________