Parent/Caregiver 1 (Primary Contact)
*
First Name
Last Name
Parent/Caregiver 2 (Secondary Contact)
First Name
Last Name
Parent/Caregiver 1 Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent/Caregiver 2 Address
(if different from Parent 1)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent/Caregiver 1 Email Address
*
Parent/Caregiver 2 Email Address
Parent/Caregiver 1 Cell Phone
*
(###)
###
####
Parent/Caregiver 2 Cell Phone
(###)
###
####
Communication
Youth 1 Name
*
First Name
Last Name
Date of Birth (Youth 1)
*
MM
DD
YYYY
Grade in School (Youth 1 )
*
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Please note any medical conditions or allergies for your youth.
If your youth is learning to manage their own schedule, we would like to include them in communications. Please select ALL methods by which we can communicate with your youth. Please note that we will ALWAYS include parents on all communications. *
If your youth is learning to manage their own schedule, we would like to include them in communications. Please select ALL methods by which we can communicate with your youth. Please note that we will ALWAYS include parents on all communications. *
Youth 1 Email
Youth 1 Cell Phone
(###)
###
####
Youth 2 Name
First Name
Last Name
Date of Birth (Youth 2)
MM
DD
YYYY
Grade in School (Youth 2)
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Please note any medical conditions or allergies for your youth.
If your youth is learning to manage their own schedule, we would like to include them in communications. Please select ALL methods by which we can communicate with your youth. Please note that we will ALWAYS include parents on all communications. *
Youth 2 Email
Youth 2 Cell Phone
(###)
###
####
Youth 3 Name
First Name
Last Name
Date of Birth (Youth 3)
MM
DD
YYYY
Grade in School (Youth 3)
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Please note any medical conditions or allergies for your youth.
If your youth is learning to manage their own schedule, we would like to include them in communications. Please select ALL methods by which we can communicate with your youth. Please note that we will ALWAYS include parents on all communications.
*
Youth 3 Email
Youth 3 Cell Phone
(###)
###
####
Youth 4 Name
First Name
Last Name
Date of Birth (Youth 4)
MM
DD
YYYY
Grade in School (Youth 4)
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Please note any medical conditions or allergies for your youth.
If your youth is learning to manage their own schedule, we would like to include them in communications. Please select ALL methods by which we can communicate with your youth. Please note that we will ALWAYS include parents on all communications. *
Youth 4 Email
Youth 4 Cell Phone
(###)
###
####
Photo Release
Activity Preferences: Regular Programming
As we are making decisions about the fall, it is very helpful to hear about your family's current comfort level with possible activity formats.
Please indicate which of the following activity formats work for your family for regular youth programming at this moment in time. Check all that apply.
Activity Preferences: In case of rain/cold
Please indicate which of the following activity formats work for your family on Sundays when it is too rainy or cold to meet outside. Check all that apply.
Is there anything else you'd like us to know?
