Participant IS ELIGIBLE to register for

CAN's YouthWorks Program!


Registering online does not guarantee a spot in the program.


The participant will be contacted by a CAN staff member to set up a professional interview for a spot in the YouthWorks program.

To register, complete the online forms below

This form includes:

  • General YouthWorks Registration Information

  • Emergency Contact Information

  • Release of Information

  • Client Rights & Responsibilities

  • Field Trip and Activity Permission 

  • Liability Waiver

  • Signature


When this form is complete, click "Submit" in the upper right-hand corner. You will receive an email confirmation when the form is submitted.

When this PDF opens, download and save it to your computer or flash drive.


We recommend that you print this PDF blank, and then complete the paper version instead of completing the boxes electronically.


Please complete this form with the participant's information, not the parent/guardian's information.

3. CA Work Permit

If 14-15 Years of Age--

CA-6 Work Permit (must be printed pink, front and back)

If 16-17 Years of Age--

CA-7 Work Permit (must be printed yellow, front and back)

Please contact Community Action Network if you have any questions.


Danielle Dicks

(734) 994-2985 ext. 132

This site is designed to provide resources &

program registration for Community Action Network &

Washtenaw County families.

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CAN Mission Statement

Community Action Network partners with children, youth, and families from under-resourced Washtenaw County neighborhoods to create better futures for themselves, and improve the communities in which they live.

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