Participant Registration Form

SPRING 2021 PARTICIPANT REGISTRATION INFORMATION

Please read below carefully: This is for YC PARTICIPANTS who have a physical disability.
DEADLINE: Forms are due on Friday, March 12.
ALL participants are required to complete a LIABILITY RELEASE form prior to attending programs. If you already completed one for 2021, you do NOT need to complete another one.
ALL participants are required to complete a MEDICAL FORM prior to attending programs. If you already completed one for 2021, you do NOT need to complete another one.
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 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.
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 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 *
Is the participant able to/comfortable with wearing a face mask during program? *
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
Grade
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: *

APRIL PROGRAMS

WHEELCHAIR BASKETBALL

Program sign up
For participants ages 8-18. Program time: 4-5:30pm @ YC, Westlake. This will be a small group program for wheelchair basketball athletes and teen volunteers.4/164/234/305/7
Transportation options. Check ONE.
Would like YC to provide round-trip transportation.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 specific information we may need when providing transportation.

MAY PROGRAMS

Please note instructions & locations: May will involve small group programs that are all outdoors. Outdoor programs are 4-5:30pm at various locations (see below). To sign up, please SELECT ALL THE DATES that you are able to attend. Participants MUST respect and follow all safety protocol standards in order to attend programs.
If the weather does not allow for outdoor programming, we will switch to INDOOR individual / small group sessions at YC or HP (on Tuesday's only) that will be 4-5pm.

MONDAY - WEST SIDE & LORAIN COUNTY

Program sign up
4-5:30pm @ various locations. For west side / Lorain County participants ages 4-18.5/3 Archery / Nature Exploration @ Bradley Woods Res., Westlake5/10 Recess Games @ Clague Park, Westlake5/17 Game Show Games @ Cahoon Park, Bay Village5/24 Sports Around the World @ Clague Park, Westlake
Transportation options. Check ONE.
Would like YC to provide round-trip transportation.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 specific information we may need when providing transportation.

TUESDAY - EAST SIDE

Program sign up
4-5:30pm @ various locations. For east side participants ages 4-18.5/4 Sports Around the World @ Horseshoe Lake Park, Shaker Hts5/11 Video Games IRL @ Cumberland Park, Cleveland Hts.5/18 Baseball @ Horseshoe Lake Park, Shaker Hts5/25 Recess Games @ Cumberland Park, Cleveland Hts.
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.

THURSDAY - WEST SIDE & LORAIN COUNTY

Program sign up
4-5:30pm @ various locations. For west side / Lorain County participants ages 4-18.5/6 Archery / Nature Exploration @ Bradley Woods Res., Westlake5/13 Recess Games @ Clague Park, Westlake5/20 Game Show Games @ Cahoon Park, Bay Village5/27 Sports Around the World @ Clague Park, Westlake
Transportation Options. Check ONE.
Would like YC to provide round-trip transportationWill 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 - LORAIN COUNTY & WEST SIDE

Program sign up
4-5:30pm @ Schwartz Rd Park, Avon. For Lorain County / west side participants ages 4-18.5/14 Sports Around the World5/21 Video Games IRL5/28 Recess Games
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.

YELP PEER SUPPORT

Program sign up
For participants ages 16-25. Programs in April will be held via Zoom. Programs in May will be outside at YC on Wednesday evenings, 6-7:30pm. Providing OWN transportation is preferred. Please contact Mackenzie if own transportation is an issue.4/14 on Zoom4/21 on Zoom4/28 on Zoom5/5 at YC5/12 at YC5/19 at YC5/26 at YC

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
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SPRING 2021 PARTICIPANT REGISTRATION INFORMATION

PARTICIPANT INFORMATION

SCHOOL INFORMATION

DEMOGRAPHICS

APRIL PROGRAMS

INDIVIDUAL SESSIONS

WHEELCHAIR BASKETBALL

MAY PROGRAMS

MONDAY - WEST SIDE & LORAIN COUNTY

TUESDAY - EAST SIDE

THURSDAY - WEST SIDE & LORAIN COUNTY

FRIDAY - LORAIN COUNTY & WEST SIDE

YELP PEER SUPPORT

RELEASE OF LIABILITY

Verification