Tween/Teen Group Registration Form

Tween/Teen Group Registration Form

Thank you for your interest in our tween/teen summer program. Please complete this form to help us determine fit, support needs, and programming considerations for your child. Submission of this form does not guarantee placement. Families will be contacted to confirm registration, availability, and any additional support requirements.
July 6-10July 13-17Both weeks

Youth Information
Youth’s full name*

First NameLast Name
Youth’s date of birth*

MonthDayYear
Youth’s age*
Youth’s school*
Current grade*
Parent/guardian name(s)*
Primary phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Email address*
example@example.com
Home address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency contact name*
Emergency contact phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to youth*

Youth Information