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About
Mission/Vision
FAQ’s
Our History
Our Partners
Our Staff
YFC Westman
Photo Gallery
Programs, News & Events
Calendar
Programs
Workshops
Spring Break
Summer
Groups
News & Events
Registration
Sample Lesson Plans
Get Involved
Invest
Volunteer
Contact Us
Registration Form
LITGROUPS 2023 Fall Registration
Please fill out the registration form below.
Also be sure to read:
Parent Information Document
Registration Information
Name of Participant (First Name, Last Name):
*
Address:
*
Street Address
Street Address Line 2
City
Postal / Zip Code
Phone number:
*
Area Code
-
Phone Number
Date of Birth:
*
Gender:
Male
Female
Program Information
I would like to register my child for (select one):
662 10th Street (Mondays and Wednesdays) Grades 4-6
My child will be:
*
walking/biking to and from LITGROUPS
picked up and dropped off at LITGROUPS
The people who have permission to pick up my child are:
Additional comments:
Parent / Guardian Information
Your relationship to the participant:
*
Parent / Guardian Address:
*
Street Address
Street Address Line 2
City
Postal / Zip Code
Parent/Guardian E-mail:
*
Emergency Contact number:
*
Area Code
-
Phone Number
Emergency Contact number #2:
Area Code
-
Phone Number
Medical Information
Allergies (list here):
Dietary allergies, issues, concerns (list here):
Medications required by participant:
Please share any additional information that would make your child's experience at this LITGROUPS event more successful
Parent Contract
I consent to my child/ward attending the YFC LITGROUPS program for the above selected dates.
*
Yes
I give permission for YFC to obtain personal information about my child/ward for the purposes of communications and registration requirements.
*
Yes
I give permission for my child's/ward's photo to be taken and used in the communication and promotion of YFC events.
Yes
I have read and understand the parent information document. (link at top of page)
*
Yes
Parent / Guardian Name:
*
First
Last
Date:
*
Submit
Reset