To sign-up for a Youth Services program please fill out the application below. For any questions regarding the Youth Services Program, please contact lpdyouthservices@lowellma.gov.

Programs Include:

  • Boxing
  • Flag Football
  • Basketball Clinics
  • Ironstone Farm Program
  • Learn to Swim Summer Program

Parent/ Guardian Name(Required)
Home Address

Emergency Contact

Please select the activity your child is interested in(Required)

Participation Information

MM slash DD slash YYYY
Address

Medical Information

Participant's Health Condition(Required)
Does your child take any medications?(Required)
Does your child have any physical restrictions?(Required)
(Example: Asthma, Allergies, etc.)
My child has the following in place at their school

This program is partially funded through the Shannon Community Safety Initiative through the Executive Office of Public Safety and Security.

The following is information required by the funding source. Any and all information requested below is for grant purposes only.
Ethnicity(Required)
Nieghborhood participant lives in(Required)
Please Check One
Recieve Public Assistance (This includes subsidized housing and food assistance)(Required)
Single Parent Household(Required)
Achievement in School
Feelings about School
Truancy
My child has trouble making friends (not fitting in, fights, etc.)
My child's friends are
How safe do you feel in your neighborhood is?