Terwillegar Junior Youth Program Registration

Registration Form

Junior Youth Spiritual Empowerment Program Edmonton
Dear Parent / Guardian:

We are pleased to invite your son/daughter to participate in the Junior Youth Spiritual Empowerment Program (JYSEP). The JYSEP is a global movement empowering groups of junior youth -- between the ages of 11 and 14 -- to become active agents of change by engaging them in a wide range of activities that include stories, sports, arts and service to the community. If you would like your son/daughter to participate, please complete this form. If you have any questions, please do not hesitate to contact us at: programs@terwillegarempowerment.org

For more information please visit https://terwillegaryouth.ca/
Participant Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
School*
Grade*
Age*
Parent / Guardian Information
Parent / Guardian Full Name*

First NameLast Name
Relationship to Participant*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Health and Liability
Does the participant have any allergies or medical conditions of which the organizers should be aware?*
Alberta Health Number (Optional)
Family Physician Name (Optional)
Family Physician Phone Number (Optional)
Please enter a valid phone number.Format: (000) 000-0000.
I agree
Transportation to and from the Program is not being provided or organized in any official capacity by the organizers of the Program. All carpools and other carsharing and transportation arrangements are being offered by individuals in a personal capacity. In the event of accident or sickness, the undersigned releases the organizers of the Program, its agents, and volunteers, from any and all liability for loss, damage or injury suffered by the participant while being transported to or from the Program.*

I understand
I agree
I agreeI do not agree
Parent / Guardian Name*
Parent / Guardian Signature*

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Registration Form

Participant Information

Parent / Guardian Information

Health and Liability