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Youth Activity Registration Form
Youth Activity Registration Form
docmedia
2023-06-27T22:03:11-07:00
Youth Programming Registration Form
First Name
(Required)
Middle Name
(Required)
Last Name
(Required)
Status Number
(Required)
Care Card Number
(Required)
Parent Cell Number
(Required)
Youth's Cell Number
Birth Date
(Required)
Month
Day
Year
Gender
(Required)
Male
Female
Other
Address
(Required)
Street Address
City
ZIP / Postal Code
Emergency Contact Name
(Required)
Emergency Contact Number
(Required)
Emergency Contact Relationship
(Required)
Email Address
(Required)
Do you have allergies?
(Required)
Yes
No
If so what are your allergies and medications?
(Required)
Can you swim?
(Required)
Yes
No
Granting of permission.
(Required)
I hereby confirm my consent, or have parent/guardian permission to:
Travel on bus or in personal vehicles
To leave the nation or country (if out of country trip)
To receive First-Aid
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