Youth Activity Registration Form - Tsawout First Nation

Youth Programming Registration Form

First Name(Required)

Middle Name(Required)

Last Name(Required)

Status Number(Required)

Care Card Number(Required)

Parent Cell Number(Required)

Youth's Cell Number

Birth Date(Required)

Gender(Required)

Address(Required)

Emergency Contact Name(Required)

Emergency Contact Number(Required)

Emergency Contact Relationship(Required)

Email Address(Required)

Do you have allergies?(Required)

Yes

If so what are your allergies and medications?(Required)

Can you swim?(Required)

Yes

Granting of permission.(Required)

I hereby confirm my consent, or have parent/guardian permission to:

Travel on bus or in personal vehicles

To leave the nation or country (if out of country trip)

To receive First-Aid