National Youth Sports Program Online Registration Form

Coulee Region National Youth Sports Program (NYSP)/ G.R.E.A.T.

WHAT IS NYSP/ G.R.E.A.T.?  The coulee Region NYSP/ G.R.E.A.T. Program is sponsored by the NCAA and the U.S. department of Heath and Human Services to provide a comprehensive sports and education program primarily for youth from low-income families (though not exclusively), ages 10 - 16.  NYSP/ G.R.E.A.T. offers experiences in a wide variety of sports and educational activities.  In addition to sports instruction and competition, the educational program addresses nutrition, personal health, higher education and career counseling.  a math and science component provides interactive, hands-on activities.  The La Crosse and Onalaska Police and La crosse Country Sheriff';s Departments will again be implementing G.R.E.A.T., a program that offers information on a variety of topics such as citizenship, alcohol, and drugs.  Participants will receive a free medic al exam (provided by NYSP/ G.R.E.A.T.), a daily USDA-approved hot lunch & snack, a free t-shirt, transportation, accident-medical insurance, as well as interaction with college students and staff.

WHO CAN COME?  EVERYBODY!  All interested students are encouraged to apply.  Although enrollment is geared primarily toward youngsters in the community whose parents(s)/guardian(s) meet the Department of Health & Human Services income guidelines, openings and anticipated in the program after priority registration is completed.

Dates: June 14 - July 16, 2004 (Weekdays)     Times:  10:45am - 4:15pm
         
Location: UW-La Crosse Mitchell Hall   Fee: FREE!
         
Registration: Application below must be submitted IMMEDIATELY.  One participant per application please.  (Tab between fields)
   
   

First Name:      Middle Name:    Last Name: 
Telephone:      E-Mail: 
Street Address:      City:      State:      Zip: 
Male:     Female:     Other:      Date of Birth:  (must be 10 prior to August 31, 2004)    Age: 
School:      NYSP Returnee:  Yes:   No:      If yes, number of years in NYSP: 
Parent or Legal Guardian:      Telephone Home:    Work: 
Emergency Contact:  Name:    Telephone Home:    Work: 
Relationship of Emergency Contact:      Address: 
City:      State:      Zip Code: 
Does participant qualify for free/reduced hot lunch program?      Does the participant qualify for medical assistance? 

I understand and consent that a medical examination will be required before enrollment in NYSP/G.R.E.A.T. and that UW-La Crosse and/or the NCAA is authorized to obtain medical care of treatment deemed necessary.

Electronic Signature:      Date: