Potcake Island

Youth Empowerment Program

Potcake Island is proud to serve as a sponsor for the 2nd Annual Youth Empowerment Program hosted by Joshua Generation.

If you would like to complete the online application form, please do so here.

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PARTICIPANT INFO: Name *

First

Last

Age *

Gender *

• Male
• Female

Child’s Tshirt Size (Free with Paid Registration)

• Youth Extra Small
• Youth Small
• Youth Medium
• Youth Large
• Youth Extra Large
• Adult Small
• Adult Medium

Grade/School *

for Number allergies

Address *

Has Your Child Attended this Program Before? *

• Yes
• No

Does your child have any food or medical allergies *

• Yes
• No

If yes, please list: *

PARENT/GUARDIAN INFO: Name *

Email *

Address (if different from child’s)

Would you like to be added to the parents’ whatsapp group for updates? *

• Yes
• No

Would You Like to Purchase an Extra Tshirt?

• Youth Extra Small
• Youth Small
• Youth Medium
• Youth Large
• Youth Extra Large
• Adult Small
• Adult Medium

PICK UP INFO: Name of person picking up child *

Relationship to Child *

Phone Number *

EMERGENCY CONTACT (Optional): Name

Phone Number:

CONSENT & ACKNOWLEDGEMENT: *

• I give permission for my child to attend the Joshua Generation Youth Empowerment Program.
• I understand and accept that my child myst follow all program rules and safety guidelines.
• I acknowledge that staff must be informed of any medical condition or allergies.

All three must be checked.

Signature of Parent/Guardian *

COURSE INTEREST: *

• Jewelry Making
• Arts & Crafts
• Junkanoo Expo
• Literacy & Numeracy
• Outdoor Adventures
• Youth Roundtable Discussions
• Natural Hair & Skin Product Creation
• Film & Drama Sessions
• Discipleship & Mentorship

What segment(s) of the program is your child most interested in? (Check all that apply.)

Submit