2024 DIWALI FESTIVAL

DIWALI FESTIVAL

November 17, 2024

4:00-6:00 PM

Berkeley Heights YMCA

Please complete one registration form per guest.

A parent/guardian is required to complete and sign the application for minors under the age of 18.
Is the attendee 18 years of age or older?*

YesNo
GUEST INFORMATION
Guest Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Email*
example@example.com
Member Status*

Berkeley Heights YMCASummit YMCAThe Learning Circle YMCANot a memberOther
Ethnic Origin*

WhiteBlack/African AmericanNative Hawaiian/Pacific IslanderAsianAmerican Indian/Alaska NativeTwo or More RacesPrefer not to sayOther
Please note: Y-USA requests the above information from YMCA participants throughout the nation for program funding and demographic purposes.

Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Relationship to Minor*
Date of Birth*

MonthDayYear
Phone Number*
ex. 555-555-5555
Parent/Guardian Email*
example@example.com
Do you want to provide Emergency Contact information that is different from the Parent/Guardian information provided above?

YesNo
EMERGENCY CONTACT INFORMATION
Name*

First NameLast Name
Phone Number*
ex. 555-555-5555
Relationship to You*