Youth Permission Slip and Registration Form

All items on this form must be completely filled out by the participant and his/her parent or guardian. 

Participant Personal Information
Name *
Name
Birth Date
Birth Date
Address
Address
Phone
Phone
Parent/Guardian & Emergency Contact Information
Name
Name
Phone
Phone
School Information
Participant Medical Information
Directions: Please check the corresponding response for the each item listed below stating current or past medical conditions *
Please select the over-the-counter medications that may be administered to your child in your absence. Only if the need arises. *
By typing your name here: