**Register for your FREE MEMBERSHIP to get rebates & discounts on our programs (See savings below).

Membership Registration Link:
YOUTH STARS MEMBERSHIP


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* 1. Please select your registration. Note that Members save 50$ off of the Online CIT program.                                                                                  
COUNSELOR-IN-TRAINING ONLINE CERTIFICATION
8 Weeks, Monday's, starting November 15 to January 24, 2021, over Zoom.
*Zoom link will be sent to participants.

No Classes on the following dates: 

December 20
December 27
January 3

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* 2. Child's full name

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* 3. Street name

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* 4. Street number

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* 5. Apartment number (if applicable)

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* 6. City / Borough

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* 7. Postal Code

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* 8. Child's age

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* 9. Child's Date of Birth

Date

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* 10. Name of child's school

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* 11. Parent/Legal Guardian 1 Name

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* 12. Parent/Legal Guardian 1 Phone Number

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* 13. Parent/Legal Guardian 1 Email

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* 14. Parent/Guardian 2 Name

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* 15. Parent/Guardian 2 Phone Number

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* 16. Parent/Guardian 2 Email

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* 17. Where did you hear Youth Stars 2021-2022 programs?

PAYMENT
E-transfers can be sent to: info@youthstars.org
Checks can be mailed to: Youth Stars 57 Westpark Ave, D.D.O, H9A 2J8
ASSUMPTION OF RISK AND INDEMNIFYING RELEASE
The parent/Guardian of the above named child hereby consent that he/she may participate in Youth Stars' C.I.T. program. I hereby release and discharge the Youth Stars Foundation, its organizers and its directors and any and all volunteers from any and all future claims or demands for loss, damage or bodily injuries which may result directly or indirectly from participation in the said activity.

PHOTO AND VIDEO CONSENT
Youth Stars Foundation reserves the right to photograph and videotape my child’s classes and/or activities, for strictly promotional purposes.

CANCELLATION FEE
YSF reserves the right to cancel the Program for which there is insufficient registration or due to unforeseen circumstances; in such a case, a full refund will be given.
There will be a 50% cancellation fee per child, for any emergency cancellation. No refund will be given after the first day of the Fall program. There will be a fee of $30.00 for any check returned by the bank.

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* 18. Please enter your name (Parent/Legal guardian)

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* 19. By entering my name electronically, I have fully read and agreed to all the terms in this document

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* 20. Please add the date on which you have filled out this form:

Date

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