Youth Parliament Bermuda - Membership Registration

Youth Parliament Bermuda - Membership Registration

All Bermuda Youth Parliamentarians are required to complete this Registration Form.
Personal Contact Information
Name

First NameLast Name
School
Year Level/Grade
Date of Birth

MonthDayYear
Date
Gender

MaleFemale
Address (Please include your parish)
Shirt Size
Email
example@example.com
Home Telephone Number
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Parent/Guardian Contact Number

First NameLast Name
Parent's Email
example@example.com
Allergies/Medical Needs (if any):

Consent for use of Photographic Material
I blanks hereby grant the officers, staff, and members of
Youth Parliament Bermuda permission to use my likeness in a photograph, video, or other digital reproduction in any and all of its publications without any consideration. I hereby irrevocably authorize the Youth Parliament Bermuda to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing itself or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or Electronic copy, wherein my likeness appears. However, I understand that I have the right to appeal to the YPB Historian if I have any queries related to my likeness in the types of media mentioned above. I hereby hold harmless and release and forever discharge Youth Parliament Bermuda from all claims, demands, and causes of action which I or any other persons acting on my behalf may have by reason of this authorization.
Applicant's Name

First NameLast Name
Applicant's Signature

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Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

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I blankshereby agree to abide by The Constitution of the Youth Parliament of Bermuda. I also understand that failure to comply with said constitution can result in my termination as an MYP (Member of Youth Parliament).
Applicant's Name

First NameLast Name
Applicant's Signature

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Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

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Should be Empty:

Personal Contact Information