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2. Applications are limited to 10 students for the school year.

4. Student's Name
5. Student's Email Address
7. Parent's Name(s)
8. Parent's Phone Number
10. Address
12. City
13. State
14. Zip Code
16. Phone Number
18. Emergency Contact(s) Name(s)
19. Emergency Contact Number
21. Release of Liability

    To the extent allowed by law, the participant hereby voluntarily waives any and all claims, both present and future, arising from his/her participation in the City of Auburn Youth Council program, including but not limited to negligence, property damage, personal injury, and wrongful death. However, nothing herein will be deemed to be a waiver of the City's responsibility for the negligence or willful acts of the City's agents and employees. Further, the participant will indemnify, defend and hold the City harmless from all costs, expenses, liability, claims, actions, causes of action, or damages sustained by reason of any occurrence causing injury or death to any person or damage to property due directly or indirectly to acts or omissions of the participant.

     

23. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
25. Electronic Student Signature
27. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
29. Electronic Parent/Guardian Signature
33. Essay Form
35. 1. Explain why you would be a good candidate for the City of Auburn Youth Council:
37. 2. Describe your future career ambitions:
39. 3. If you were Mayor, describe two areas/attributes of the city you’d improve and how:

43. Teacher Recommendation form (page 3 of the printable application) must be completed and emailed to bmcoburn@ci.auburn.in.us or uploaded here.

    Student will not be considered unless this form is completed by a teacher. 

46. Upload Teacher Recommendation Form
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field