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Northwest Washington Parks Youth Outreach Program

  1. Thank you for your interest in our Youth Outreach Program for ages 14-18!


    This information will be collected and sent to the Assistant Region Manager of the Northwest Region of the Washington State Parks and Recreation Commission in order to select members for this new program for the 22/23 school year.  

    *The deadline to submit this form is Friday, Oct. 28, 2022. Participants are expected to be chosen and notified by email.

    NOTES 

    • Parental and/or guardian permission will be required for participation in our Youth Outreach Program 
    • Please fill in the "Reply Email" AND check "Receive email copy of this form" and fill in your email address again before you click "SUBMIT"  to have a copy of this form sent to your email

    For further information you may contact:

    John Keates
    Assistant Northwest Region Manager -- Washington State Parks
    220 N. Walnut St.
    Burlington, WA 98233

    Email: john.keates@parks.wa.gov
    Phone: Office - (360) 755-9231 Cell - (call or text) 360-899-8268

  2. Which of the following best describes your gender?

    Check all that apply

  3. How would you describe your ethnicity?

    Check all that apply

  4. What is your age?*
  5. Do you identify with any of the following communities?

    Check all that apply

  6. Please provide an email address so that we may send you information on our youth programs.

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  8. This field is not part of the form submission.