YMCA Youth Transitions Program Referral Form

YMCA Youth Transitions Program Referral Form
Date of Referral

MonthDayYear
Date
Caregiver/Referrer Information
Are you a caregiver for the referred youth, or a referring agency?

I am a caregiverI am from a referring agency
Caregiver Information
Your Name or Caregiver's Name*

First NameLast Name
Caregiver Phone Number*
Please enter a valid phone number.
Caregiver Email*
example@example.com
Referrer Information
Referring Agency Name*
If there is no referring agency, please fill out with your own name.
Contact Name*

First NameLast Name
Contact Email*
example@example.com
Contact Phone Number*
Please enter a valid phone number.
Reason for Referral*

SKY High Information
SKY High is a free, highly-engaging YTP program aimed at fostering resiliency, leadership and community connection in Edmonton. During summer, SKY High takes place Monday through Friday, 9am–3:30pm during and features an outdoor adventure (two nights camping). SKY High is hosted by youth support workers from YMCA Youth Transitions Program and offers workshops, presentations and fun, challenging activities.

SKY High Sessions for 2024:

First Session: July 22–26 at Boyle Street Plaza

Second Session: July 29–30 at Boyle Street Plaza & July 31–August 2 at Wabamun Lake
Please indicate which SKY High session the youth is interested in attending:*

First Session (July 22–26 at Boyle Street Plaza)Second Session (July 29–30 at Boyle Street Plaza & July 31–August 2 at Wabamun Lake)
Please note: Participants must complete an application and interview process to be accepted to the July 29–August 2 SKY High session. A youth support worker will contact you after you have completed a referral form and expressed interest in attending SKY High.

How did you hear about Youth Transitions Program?

Social mediaWebsite AdBillboardNewspaper/magazineRadioYMCA websiteWord of mouthOther
Should be Empty:

Caregiver/Referrer Information