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Talk to Us About Your Young Athlete
First Name
*
Last Name
*
Email
*
Address
*
City
*
State
*
Zip
*
Do you participate in a Young Athletes Program currently?
*
Do you participate in a Young Athletes Program currently?
No, but I am interested in a local program
Yes, at home
Yes, at school
Yes, in our community
Are you interested in becoming a Young/Athletes Leader?
*
Are you interested in becoming a Young/Athletes Leader?
Yes
No
Region
*
Select your region
Capital: Albany, Columbia, Fulton, Greene, Hamilton, Montgomery, Rensselaer, Saratoga, Schenectady Schoharie, Warren, Washington
Central: Cayuga, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego
Genesee: Chemung, Genesee, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Wyoming, Yates
Hudson Valley: Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester
Long Island: Nassau and Suffolk
New York City: Brooklyn, Bronx, Manhattan, Queens, Staten Island
North Country: Clinton, Essex, Franklin, Lawrence
Southern Tier: Broome, Chenango, Cortland, Delaware, Otsego, Tioga, Tompkins
Western: Allegany, Cattaraugus, Chautauqua, Erie, Niagara, Orleans
County
Message
*
Child(ren)'s Names:
*
Child(ren)'s Age:
*
The Young Athletes Program is designed for children with or without intellectual/developmental disabilities. Which of these applies to your children or the children that you care for?
*
The Young Athletes Program is designed for children with or without intellectual/developmental disabilities. Which of these applies to your children or the children that you care for?
I have child(ren) with AND without intellectual/developmental disabilities interested in participating
I have child(ren) with intellectual/developmental disabilities interested in participating
I have child(ren) without intellectual/developmental disabilities interested in participating
If you currently participant in a Young Athletes program, what program is it?
*
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