• 2026-2027 Teen Registration Form

    To participate in any Santiam Teen Center (STC) programs or activities, each teen must have a completed registration form on file. This form must be filled out by a legal guardian before the teen is allowed to attend or engage in services at STC. The information provided should be accurate and kept up to date. All personal details will remain confidential and used only for program and safety purposes. STC staff will contact the primary guardian listed to verify the information submitted.
  • Does your teen have a preferred name/pronouns?*
  • Gender (Legal)*
  • Grade (2026-2027)*
  • School Attending (2026-2027)*
  • What year will your teen graduate?*
  • Does this Teen have a second home address?*
  • Does your teen have a cellphone or email?*
  • Format: (000) 000-0000.
  • I give permission to the Santiam Teen Center to use photographs or video footage of my teen for promotional and advertising purposes. This may include, but is not limited to, use in printed materials, online publications, social media, brochures, articles, and the organization's website.*

  • Teen Medical Information

  • Does your teen have any allergies (including food, medication, environmental)?*
  • Does your teen have any medical, developmental, or mental health needs that would help us support them well? (Examples: asthma, diabetes, seizures, ADHD, autism, anxiety, depression, etc.) This information is only shared with STC staff and mentors who need to know so we can keep your teen safe and ensure they have a positive, enjoyable experience at the center.*
  • Does your teen take any medications (regularly or as needed)? This information is only for STC staff in case of an emergency, so we can respond quickly and keep your teen safe and supported.*
  • Permission to support teen in Self-Administered First Aid (e.g., bandages, icepacks). No over the counter medication will be made available to teens.*
  • Permission to call 911 for an ambulance for emergency medical care.*

  • Guardian(s) and Emergency Contact(s)

    In the event of an emergency, STC will always contact the Primary Guardian first. If we are unable to reach them, we will then contact the other listed guardians in the order of their guardian status. If no guardians can be reached, we will move to the emergency contacts you provided.
  • Format: (000) 000-0000.
  • We occasionally send important updates (unexpected closures, schedule changes, or fun special events). How would you like us to reach you? *
  • Additional Legal Guardian(s)?*
    • Guardian 2 
    • Format: (000) 000-0000.
    • We occasionally send important updates (unexpected closures, schedule changes, or fun special events). Would this guardian like us to contact them with these updates? *
    • Guardian 3 
    • Format: (000) 000-0000.
    • We occasionally send important updates (unexpected closures, schedule changes, or fun special events). Would this guardian like us to contact them with these updates? *
    • Guardian 4 
    • Format: (000) 000-0000.
    • We occasionally send important updates (unexpected closures, schedule changes, or fun special events). Would this guardian like us to contact them with these updates? *
    •  

  • Emergency Contact(s)

    We will always contact the listed guardians first in an emergency, in the order they are provided. Please also list an additional emergency contact (someone other than the guardians) whom we may reach only if the guardians are unavailable.
  • Format: (000) 000-0000.
  • Would you like to add another emergency contact?
  • Format: (000) 000-0000.

  • Guardian Consent & Review Forms

    Teen Policy Forms for Guardian Awareness (Teens Sign at STC; Guardian Signs Waiver)

  • Attached Forms – Please Review

    The following forms are provided so you are aware of the expectations, policies, and procedures:

    • Behavioral Policy
    • Zero Tolerance Policy
    • Code of Conduct
    • Waiver & Release of Liability
    • Occupancy & Participation Notice

    Please read each document carefully. Your teen will go over these policies with a staff member during orientation and will sign their own copies at that time.

    The Primary Guardian must sign the Waiver & Release of Liability before your teen can participate.

    All other forms are for your awareness only. You will be asked to check boxes confirming you have read and understand each document.

  • STC Code of Conduct & Disciplinary Policies

    Please review our Behavior Policy, Code of Conduct, and Zero Tolerance Policy. Your teen will go over these guidelines with the Program Director during registration and will sign their own copy to confirm understanding.

  • STC Waiver and Release of Liability

    As part of our commitment to safety and accountability, we ask that you (the guardian) review and agree to the Waiver and Release of Liability. This confirms your understanding of the risks involved in Santiam Teen Center programs and releases Santiam Teen Center, its staff, and volunteers from related claims. It also includes your consent for staff to provide social-emotional support and crisis intervention if needed.

  • Occupancy & Participation Notice

    Santiam Teen Center has a strict in‑building occupancy limit of 26 people total, including teens, staff, and volunteers. If we reach capacity, teens who are not actively participating in services may be asked to leave early to ensure we remain within safety limits. When teens arrive, they complete a brief check‑in survey indicating which services they plan to use that day. Teens are expected to follow all rules and treat others respectfully while in the building. Repeated misconduct may result in loss of attendance privileges.
  • Today's Date*
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