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Home
COVID-19 Programs
About HYPU
Board of Directors
Leadership Team
Community Donors and Volunteers
Programs and Services
Youth Circles
Youth & Community Pop Ups
Scholarship Program
Scholarship 2020
Scholarship 2019
Scholarship 2018
Senior Day Program
Senior Recipes
Hmong Enrichment Summer Camp
Performing Arts & Culture Program
Community Classes Recap
Naturalization and Citizenship Service
Disparity Prevention Program
Community Resources
COVID-19 Resources
Harm Reduction Resources
Domestic Violence Resources
Suicide Prevention Resources
Youth Resources
Make a Donation
Smile Amazon
Contact Us
Employment Opportunities
Volunteer with Us!
Sacramento, California
All Student Registration Form
Registration due by Friday, June 5, 2020.
This form is also used for the High School Hmong Leadership Class.
Spots are limited. The Program Coordinator will send an email to confirm registration.
Direct any questions or concerns to the Program Coordinator:
Kao Nue Xiong
kaonue.xiong@hypu.org
(916) 947-8524
1. Student Information
*
Indicates required field
Legal Name
*
First
Last
Hmong Name
*
Will be used during programming
Date of Birth
*
Age
*
Gender
*
-Select Gender-
Female
Male
Non-Binary/Gender Fluid
2020-2021 Grade Level
*
-Select Grade Level-
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
School
*
School District
*
Home Address
*
City, State
*
Zipcode
*
Phone Number
*
Email Address
*
2. Emergency Contact Information
Parent/Guardian
*
Relationship
*
Contact Number
*
Parent/Guardian
*
Email Address
*
Relationship
*
Contact Number
*
Email Address
*
3. Medical Information
In the event of an accident or other emergency when a parent/guardian is unavailable, I hereby authorize the program to make necessary arrangements for my child to receive medical or hospital care, including transportation. I agree to pay all costs incurred. Under the above circumstances, I further authorize the physician named below to undertake such care and treatment of my child as necessary. In the event said physician is not available, I authorize such care and treatment to be performed by a licensed physician or surgeon.
Doctor's Name
*
Address
*
Health Coverage
*
Phone Number
*
City, State, Zip Code
*
Hospital
*
List any medications or special health care procedures:
*
List any food allergies:
*
4. Student Survey
Please answer the following questions as best as you can.
(a) Is your child in any of the following programs or receiving any of the following services?
Select as many as applicable
*
Special Education (IEP and 504)
GATE (Gifted and Talented Education)
ELL (English Language Learner)
Counseling
Homeless Services
Tutoring
Behavioral Management
(b) Check the HYPU programs your child has participated in.
Select as many as applicable
*
2013 HESC
2014 HESC
2015 HESC
2016 HESC
2017 HESC
2018 HESC
2018 Quarterly Courses: Hmong 1
2018 Quarterly Courses: Hmong 2
2019 Quarterly Courses: Hmong 1
The Heights Dance Program
2020 Performing Arts and Culture Program
First time enrolled in HYPU programs
(c) Student Hmong Language Fluency
My child can speak in Hmong
*
Not at all
Somewhat
Good
Fluently
My child understands Hmong
*
Not at all
Somewhat
Good
Fluently
My child can read in Hmong
*
Not at all
Somewhat
Good
Fluently
My child can write in Hmong
*
Not at all
Somewhat
Good
Fluently
(e) What are your expectations of the program?
Comment
*
(f) What would you like us to know about your child?
Comment
*
How did you hear about this program?
*
--Select One--
Social Media (Facebook, Instagram)
Website
Family/Friends
Radio
Email
Other
5. Student Photo/ Video/ Product Release
I hereby give the the District and summer program, its employees, assigns and agents permission to utilize and/or publish work my child produces during summer activities and to utilize and/or publish photographs or video taken during program activities or at special events sponsored by the District and the summer program where my child may appear. These photographs, student products, and video materials may be used in publications, audiovisual presentations, promotional literature, advertising, or any other manner without compensation to the child, parents, or guardian.
By initialing below, I consent to the Photo/Video/Product Release
*
6. Parent Signature
By signing, you verify that all information provided on this form are accurate.
Electronic Signature
*
Date of Signature
*
Submit
Home
COVID-19 Programs
About HYPU
Board of Directors
Leadership Team
Community Donors and Volunteers
Programs and Services
Youth Circles
Youth & Community Pop Ups
Scholarship Program
Scholarship 2020
Scholarship 2019
Scholarship 2018
Senior Day Program
Senior Recipes
Hmong Enrichment Summer Camp
Performing Arts & Culture Program
Community Classes Recap
Naturalization and Citizenship Service
Disparity Prevention Program
Community Resources
COVID-19 Resources
Harm Reduction Resources
Domestic Violence Resources
Suicide Prevention Resources
Youth Resources
Make a Donation
Smile Amazon
Contact Us
Employment Opportunities
Volunteer with Us!