New Member Form
Teen Information
Name
*
First Name
Middle Initial
Last Name
Gender
*
Birthdate
*
Grade
*
Please Select
7th
8th
9th
10th
11th
12th
School
*
Your child identified themself as...
*
Please Select
Deaf
DeafBlind
Deaf-Plus
Hard of Hearing
Hearing Loss
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number (If have)
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
T-shirt Size
*
Please Select
S
M
L
XL
Parent/Guardian Information
Name
*
First Name
Last Name
Relation to Teen
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Preferred Mode of Contact
*
Email
Text
Call
Emergency Contact #1
Name
*
First Name
Last Name
Relation to Teen
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact #2
Name
*
First Name
Last Name
Relation to Teen
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Teen's Medical Conditions
Does your child have health issues that we should be aware of?
*
Yes
No
If "Yes", explain:
Should paramedics be called if a situation occurs?
*
Yes
No
Is your child allergic to any type of food or medication?
*
Yes
No
If "Yes", explain:
RELEASE, PARTICIPANT WAIVER AND HOLD HARMLESS FORM
Parent or Legal Guardian Name
*
First Name
Last Name
Teen Name
First Name
Last Name
Parent or Legal Guardian Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: