Community Youth Development

Enrollment Form

Ex: 9th
Ex: Abilene High School

By signing below, I agree that I have been provided information on the referenced Prevention and Early Intervention Program and wish to receive services. I understand that data on my child/youth/family will be collected, maintained and entered in a secure database. The information will be utilized to track services for evaluation purposes and to ensure quality services are being provided. I hereby authorize my child/youth/family to participate in the program.

Signature is required.
reCAPTCHA is required.