Participant Registration Form

FALL 2020 PARTICIPANT REGISTRATION INFORMATION

Please read below carefully: This is for YC PARTICIPANTS who have a physical disability.
DEADLINE: Forms are due on Tuesday, September 1.
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.
Program options: Virtual and in-person. All in-person programs will be held outdoors through the end of October. As time goes on, we will continue to monitor the status of the COVID-19 situation and hopefully proceed with safe indoor programming in November. Stay tuned!
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 *
For in-person programs, is the participant able to/comfortable with wearing a mask when needed (i.e. restroom)? *
Emergency contact name (other than contact listed above) *
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 GOLF - WEST SIDE / LC

Golf
4-5:30pm at N. Olmsted Golf Course. For west side / Lorain County participants ages 8-18.9/169/239/30
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.

WEDNESDAY - VIRTUAL PROGRAMS

Open to participants of all ages. Programs will be on Wednesday's from 3-4pm and held through Zoom video conference software.
Virtual Programs Sign-up
9/16 Fitness Frenzy9/23 Fitness Frenzy9/30 Guided Drawing10/7 Guided Drawing10/14 Game Night10/21 No-Bake Bonanza10/28 Halloween Party

WEDNESDAY - YELP PEER SUPPORT

YELP Peer Support
For participants ages 16-25. Programs will be outside 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.9/169/239/3010/710/1410/2110/28

WEEKEND / OTHER PROGRAMS

HALLOWEEN DRIVE-IN MOVIE
Open to participants of all ages and families. Program is 6-9pm at YC, Westlake. Must provide OWN transportation. Space is limited and will be assigned on a first come basis.10/17
ONE-ON-ONE APPOINTMENTS
Open to participants of all ages. With school schedules varying and less in-person program opportunities, we're opening up our building during the day for participants to focus on some individualized coaching, in FITNESS, NUTRITION, and ART. Please check below all areas that you are interested to come in and hone your skills alongside YC staff and a volunteer. Appointments are open to other areas besides fitness, nutrition, and art. Please let us know below if you have something else you'd like to make an appointment for.FitnessNutritionArtOther
If you selected "other" - what would you like to do?
Availability for one-on-one appointments:
Select all of the time frames that you are available for appointments during the week. Transportation may be provided for most days.Mornings before 12pmAfternoons between 12-2pmEarly evenings between 3-5pm

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 for the summer).
Please date this form *

Verification

Please enter any two digits *Example: 12
This box is for spam protection - please leave it blank:

Participant Registration Form

FALL 2020 PARTICIPANT REGISTRATION INFORMATION

PARTICIPANT INFORMATION

SCHOOL INFORMATION

DEMOGRAPHICS

MONDAY PROGRAMS - EAST, WEST, & LC

TUESDAY PROGRAMS - EAST SIDE & CENTRAL CLEVELAND

WEDNESDAY GOLF - WEST SIDE / LC

WEDNESDAY - VIRTUAL PROGRAMS

WEDNESDAY - YELP PEER SUPPORT

THURSDAY PROGRAMS - WEST SIDE & LORAIN COUNTY

FRIDAY TEAM YC SOCCER

WEEKEND / OTHER PROGRAMS

RELEASE OF LIABILITY

Verification