Registration Form

LITGROUPS 2024 Summer Registration

 

Please fill out the registration form below.

 

Also be sure to read:

Registration Information

Name of Participant:*
Address:*
Phone number:*
-
Date of Birth:*
Gender:

Please select which weeks you would like to register for:

Mornings at 662-10th Street from 10:00 am - 12:00 pm (you may select more than one week)
Afternoons at Green Acres from 2:00 pm - 4:00 pm (you may select more than one week):
My child will be:*
The people who have permission to pick up my child are:
Additional comments:

Parent / Guardian Information

Your relationship to the participant:*
Parent / Guardian Address:*
Parent/Guardian E-mail:*
Emergency Contact number:*
-
Emergency Contact number #2:
-

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 summer program for the above selected dates.*
I give permission for YFC to obtain personal information about my child/ward for the purposes of communications and registration requirements.*
I have read and understand the parent information document. (link at top of page)*
Parent / Guardian Name:*
Date:*
Word Verification: