Youth Night Registration Form

1
PARENT NAME
First Name
Last Name
2
Phone Number
Please enter a valid phone number.
3
Email Address
example@example.com
4
Student Name
First Name
Last Name
5
Student Grade (6th - 12th)
Please Select
Please Select
6th
7th
8th
9th
10
11th
12th
6
School Name
7
Student Age
8
Emergency Contact Name
First Name
Last Name
9
Emergency Contact Phone
Please enter a valid phone number.
10
Does the student have any allergies or medical conditions we should know about?
Huge
Large
Normal
Small
Ok
Ok
11
Phone Number
Please enter a valid phone number.
12
Phone Number
Please enter a valid phone number.
13
Checkbox required:
I give permission for my child to participate in Youth Night hosted by Lead Through Athletics at 4 Quarters Gym.
I understand this event includes recreational activities such as basketball and games.
I give permission for my child to appear in photos or videos for program promotion.
14
Are you interested in volunteering with Lead Through Athletics?
YESNO
15
Does your child have any allergies or medical needs we should be aware of?(Short paragraph response)
Huge
Large
Normal
Small
Ok
Ok
16
Do you have additional children who may join the program?
Yes
No
Maybe later
17
If YES:12a. Please list their names & grades.
18
Do you have any prayer request?
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: