Youth Movement Project

Parent/Guardian's Full Name *


Parent/Guardian's full address (number, street, city/town, ON, Postal Code) *


Parent/Guardian's Home Phone *


Parent Guardian's Cellular Phone


Your Email *


1. Youth's Full Name *


1. Date of Birth (DD-MM-YY) *


1. Health Concerns (Please list all, including Allergies, Asthma, Learning Difficulties, Medications, Diseases and Disorders) *


1. Any Accomodations needed


2. Youth's Full Name


2. Date of Birth (DD-MM-YY)


2. Health Concerns (Please list all, including Allergies, Asthma, Learning Difficulties, Medications, Diseases and Disorders)


2. Any Accomodations needed


3. Youth's Full Name


3. Date of Birth (DD-MM-YY)


3. Health Concerns (Please list all, including Allergies, Asthma, Learning Difficulties, Medications, Diseases and Disorders)


3. Any Accomodations needed


4. Youth's Full Name


4. Date of Birth (DD-MM-YY)


4. Health Concerns (Please list all, including Allergies, Asthma, Learning Difficulties, Medications, Diseases and Disorders)


4. Any Accomodations needed


I have read the Participant Conduct and agree *

I have read the Assumption of Risk and Waiver of Liability and agree *

I have read the Acknowledgement of Understanding and agree *