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Youth Enrollment Form
1

Youth Information

Personal details of the applying youth member
2

Home Address

Primary residential address
3

Parent / Guardian Information

Primary and secondary guardian details
Primary Parent / Guardian

Secondary Parent / Guardian (if applicable)
4

Family Information

Household composition and siblings
Siblings / Other Household Members

5

Contact Information

Emergency contacts and communication preferences
Emergency Contact #1

Emergency Contact #2

Pick-Up Authorization

Communication Preferences
6

Medical Information

Health and medical history — kept strictly confidential

7

Photo & Video Permission

Media release and usage authorization

From time to time, our organization photographs and records video of youth participants during activities, events, and programs. These images and videos may be used for newsletters, websites, social media, promotional materials, and grant applications. Please indicate your consent below.

8

Waiver & Responsibilities

Please read carefully before signing

Participation Agreement & Release of Liability

I/We, the undersigned parent(s)/guardian(s), hereby authorize the above-named youth to participate in all activities, programs, and events organized by this organization. I/We understand that participation may involve physical activities that carry a risk of injury.

I/We agree to assume all risks associated with participation and release, discharge, and hold harmless the organization, its officers, directors, employees, and volunteers from any and all liability, claims, demands, or causes of action that may arise from participation in activities, whether caused by negligence or otherwise.

Medical Authorization

I/We authorize the organization to obtain emergency medical treatment for the above-named youth in the event that I/we cannot be reached. I/We agree to be responsible for all medical expenses incurred. Every effort will be made to contact a parent/guardian before seeking emergency treatment.

Code of Conduct Agreement

I/We acknowledge that youth participants are expected to behave respectfully toward all staff, volunteers, and fellow participants. Bullying, harassment, discrimination, or disruptive behavior may result in suspension or removal from the program. I/We agree to support the enforcement of these standards.

Attendance & Commitment

I/We understand that regular attendance and punctuality are important for program success. I/We agree to notify the organization in advance when the youth will be absent. I/We understand that repeated unexcused absences may affect enrollment status.

Privacy Notice

All information provided in this form is collected solely for program administration and safety purposes. Information will not be sold or shared with third parties without consent, except as required by law.

Photo & Media Agreement

By signing below, I/we acknowledge the photo and video permissions selected above and understand that permissions may be revoked at any time by providing written notice to the organization.


9

Additional Information

Program interests and anything else we should know
✓ Application submitted successfully! A confirmation has been sent to the administrator on file.