Participant Registration

Has anything changed from your most recent YC medical form submission?(Required)

Yes

No

Participant Information

Participant Name(Required)

First Last

Birth Date(Required)

Parent/ Guardian Information

Parent/Guardian Name(Required)

First Last

Parent/Guardian Cell Phone(Required)

Other Phone Number

Parent/Guardian Email(Required)

Preferred Phone for Program Reminder Texts

School & Transportation Information
Please provide ALL school information below to help us with routing for programs.

School Name

School Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Earliest time child can be picked up from school

:

Latest time child can be picked up from school

:

Time child arrives home from school

:

We prefer that an adult is present during drop off. Can your participant be dropped off at home alone? Must be older than 12.(Required)

Yes

No

Transportation Options(Required)

Would like YC to provide round trip transportation

Will provide own transportation

Would like YC to provide one-way transportation TO program

Would like YC to provide one-way transportation HOME AFTER program

Transportation details: Please provide any specific info we may need when providing transportation.

For Registration Questions