Youth Challenge Academy | Online Application

Online Application – Kalaeloa

"*" indicates required fields

Applicant Name*

First Last

Applicant Gender*

Male

Female

Applicant Birth Date*

Applicant Age on 01/17/2024*

Please enter a number from 15 to 18.

Is your child born after June 01, 2008?*

Yes

If your child is 15-year-old and born after the above date, they will not be eligible for this class but may be eligible for the next class.

Parent/ Guardian Name

First Last

Relationship

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Current High School*

What cycle are you looking to enroll in?*

SPRING (January 2024 - June 2024) [Class 60]

Please select your Orientation date*

How did you hear about the program?*

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