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Student Application
Please fill out the form below. All information is strictly confidential and private. 

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)

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 avoid horseplay and intimate contact while at Tyler's House KC

  • 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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