Participant Registration Form

FALL 2020 PARTICIPANT REGISTRATION INFORMATION - November & December

Please read below carefully: This is for YC PARTICIPANTS who have a physical disability.
DEADLINE: Forms are due on Wednesday, October 21.
ALL participants are required to complete a LIABILITY RELEASE form prior to attending programs.
ALL participants are required to complete a MEDICAL FORM for 2020 prior to attending programs.
This is NOT your official schedule. Youth Challenge will send e-mail confirmation of the calendar once your selections have been reviewed AFTER the deadline.
Programs will be implemented similarly to how we did over the summer, following CDC and Ohio Dept. of Health guidelines. We are all about adapting and we have created a safe plan to try to see as many of you as possible.
ALL participants, volunteers and staff are required to wear a mask at all times for indoor programs.
SUGGESTED DONATIONS: YC suggests a donation of $10 per program during this season. Suggested donation amounts can be paid at your convenience. Again, this is a suggested donation and no participant will be denied programming for lack of monetary payment.
TRANSPORTATION: This Fall, YC is encouraging participants to provide their own transportation, if possible. For those who are unable to provide own transportation, YC is able to provide transportation for most programs. There is an option to provide detailed transportation information (such as alternative address or specific instruction for staff/drivers).
**Please complete the ENTIRE registration form and click "submit" at the end. For REGISTRATION QUESTIONS, contact: Mackenzie Vecchio, Director of Program Services, at mvecchio@youthchallengesports.com or (440) 892-1001 x 18.

PARTICIPANT INFORMATION

Participant Last Name *
Participant First Name *
Participant date of birth *
Participant age *
Street Address *
City *
Zip code *
Primary Contact Name *
Primary Contact Email *
Primary Contact Phone Number *
Can receive text messages *
YesNo
Participant's physical disability *
Masks will be required at all times this season. Is the participant comfortable wearing a mask for the duration of each program? *
Emergency contact name (other than contact listed above) *
Parent / guardian #1 name: *
Parent / guardian #1 place of employment: *
Parent / guardian #2 name:
Parent / guardian #2 place of employment
Emergency contact phone number *

SCHOOL INFORMATION

Is the participant attending school in-person, virtual from home, or a mix of in-person and virtual? *
School Name
School Street Address
School City
School Zip Code
School Phone Number
Dismissal time HHMMAM/PM
Earliest participant can be picked up from school HHMMAM/PM
Latest participant can be picked up from school HHMMAM/PM
Time participant arrives home from school HHMMAM/PM

DEMOGRAPHICS

Please note: Youth Challenge receives substantial funding from Foundations and Community Partners. Often, they require certain demographic and income data to ensure that their grantees meet requirement set forth in specific funding guidelines. If you are comfortable doing so, please complete the following section which includes questions relating to household income, education, and race/ethnicity. This section is not required and information provided will not be shared.
Participant's gender: *
Participant's ethnicity: *
Parent education level: *
Family income: *

WEDNESDAY - YELP PEER SUPPORT

YELP Peer Support
For participants ages 16-25. Programs will be at YC on Wednesday evenings, 6-7:30pm. Must provide OWN transportation to and from program. Please contact Mackenzie if own transportation is an issue.11/411/1111/1812/212/9

FRIDAY - EAST

Please see programs, locations and restrictions: For East Side participants ages 4-18. Program time 4-5:30pm.
BASKETBALL
4-5:30pm at YC, Westlake11/611/13
FOOTBALL
4-5:30pm at location TBD.12/412/11
Transportation options. Check ONE.
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 information we may need when providing transportation.

FRIDAY - ALL

ART
For participants ages 4-18. Program time 4-5:30pm @ Bay Arts, Bay Village11/20
Transportation options. Check ONE
Would like YC to provide round-trip transportation to and from program.Will provide own transportation to and from program.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 information we may need when providing transportation.

RELEASE OF LIABILITY

Release of liability will be sent to you in separate email to complete and return PRIOR to attending programs (if you did not already complete one).
Please date this form *

Verification

Please enter any two digits *Example: 12
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FALL 2020 PARTICIPANT REGISTRATION INFORMATION - November & December

PARTICIPANT INFORMATION

SCHOOL INFORMATION

DEMOGRAPHICS

MONDAY - WEST SIDE / LORAIN

WEDNESDAY - YELP PEER SUPPORT

FRIDAY - EAST

FRIDAY - ALL

RELEASE OF LIABILITY

Verification