MDJ Youth Membership Registration Form (English)

MDJ Pierrefonds Membership Form (English)

Welcome to Maison des Jeunes Pierrefonds! 🎉 We're excited to have you join our community—a fun, safe space where youth can hang out, participate in activities, and get support. Please fill out this form to become a member. Membership is free and gives you access to all our programs, events, and resources!
Name of Youth (Legal Name)

First NameLast Name
Name youth goes by (nickname)
Youth E-mail
Youth Phone Number

Area CodePhone Number
Youth Birth Date

MonthDayYear
School
Youth Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Information

Please note that all information provided is strictly for the well-being of your child. It is collected solely for emergency purposes and will only be shared if necessary to ensure their safety.
Youth Medical Information
Emergency Contact #1
Emergency Contact #2
MDJ Rules

Please review the MDJ Youth Guidebook – Terms & Conditions (in the link below) to understand the rules and expectations for all youth members. Failure to follow these guidelines may result in suspension or termination of membership. The most important rule: always show respect for yourself and those around you.
Guardian Consent & Information
Guardian Information
As the parent/legal guardian of the minor, I authorize MDJ Pierrefonds to distribute any image or video taken of my child during MDJ hours/events on their website and social media for non-commercial purposes.
Parent / Guardian: Please sign here to confirm your consent to your child to attend Maison des Jeunes de Pierrefonds and agree to all terms and conditions.
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
Should be Empty:

MDJ Pierrefonds Membership Form (English)

Emergency Information

MDJ Rules

Guardian Consent & Information