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Student Application
Please fill out the form below. All information is strictly confidential and private. Program duration includes February, March, April, and May. Must attend at least 75% of programming activities. 

*Orientation is required for students and parents.

Students must be enrolled in a local high school, grades 9 through 12, or be homeschooled.


Student's Information

Race/Ethnic Origin

Home Address

1. Parent/Guardian Name

2. Parent/Guardian Name (optional)

Member Benefits Include:

  • Access to all programming activities

  • Name badge

  • Leadership roles

  • Field trips fee coverage

  • Hands-on training

  • Access to special resources

  • Light snacks and food


To qualify for programs/events at Tyler's House KC, students must meet the criteria listed above. We reserve the right to deny services at any time based on any of the aforementioned eligibility requirements or for any other reason, including the actions/inactions of the student, parent, or guardian. These eligibility requirements are subject to change without notice.

Please read each student code agreement


  • I will honor Tyler's House KC and other's space and property by treating others the way I want to be treated

  • I will promote kindness and encourage others, rather than put them down with hurtful comments.

  • I will respect Tyler's House KC staff and volunteers by giving them my full attention when asked


  • I will promote an alcohol, tobacco, drug and violence free environment at Tyler's House KC activities

  • I will use appropriate language at all times while at Tyler's House KC

  • I will be responsible for my actions and attitude by being open and teachable

  • I will help keep Tyler's House KC clean and accessible to all 


  • I will attend the events I sign up for and I will let Tyler's House KC know 24 hours in advance if I cannot attend

  • I will remain in the immediate area of the event for the entirety of the event unless I have communicated with staff and my parent(s), and I have received permission to leave

I commit to these Agreements and I understand attendance at Tyler's House KC is a privilege and voluntary. Tyler's House KC reserves the right to contact the student’s parent(s)/guardian and/or the authorities as appropriate for the situation.

Student Signature

Thanks for completing the Student Application! Your Parent/Guardian will receive an email with permission forms they need to complete for you to attend events at Tyler's House KC. 

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