Participant Registration Form

WINTER / SPRING 2020 PARTICIPANT REGISTRATION INFORMATION

Please note the following: This is for YC PARTICIPANTS who have a physical disability.
DEADLINE: Forms are due on Monday, January 6.
ALL participants are required to complete a MEDICAL FORM for 2020.
This is NOT your official schedule. Youth Challenge will send e-mail confirmation of the calendar once your selections have been reviewed AFTER the January 6th deadline.
PLEASE READ PROGRAM RESTRICTIONS AND TRANSPORTATION OPTIONS CAREFULLY. Transportation options and restrictions are listed for each section and program.
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: YC is able to provide transportation for many, but not all programs. If YC can provide transportation, the option is listed in a menu after the program selection section. Some programs may have a geographic priority for transportation. There is also 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, Program Manager, 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: *
Emergency contact name (other than primary contact above): *
Emergency contact phone number: *

SCHOOL INFORMATION

Please provide ALL of the below school information to will help us with our transportation routing.
Is your child attending a NEW school this year?
YesNo
School Name
School Street Address
School City
School Zip Code
School Phone Number
School Dismissal Time HHMMAM/PM
Earliest child can be picked up from school HHMMAM/PM
Latest child can be picked up from school HHMMAM/PM
Time child usually 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: *

Verification

Please enter any two digits *Example: 12
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