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2. 
3. Westland Youth Works! Youth Registration Form

   The City of Westland is happy you are interested in this great program! Please fill out the information below to get registered for the program and we will reach out to help connect you to one of the City's great business partners.

7. General Information
9. First Name*
10. Last Name*
12. Email Address
13. Phone Number*
15. Street Address*
17. City*
19. ZIP Code*
21. Date of Birth*
    Date of Birth
23. Gender*
    -- Select One --MaleFemaleNon-reported
25. Type of job that you are interested in?
29. Parent / Guardian Information & Emergency Contact
31. Parent / Guardian First & Last Name*
33. Parent / Guardian Phone Number*
35. Emergency Contact First & Last Name*
37. Emergency Contact Phone Number*
41. Terms & Conditions
43. Electronic Signature Agreement*

    I understand and accept that completion and submission of this application does not guarantee employment.

    1. I agree.
45. Electronic Signature
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field