YRC Programs Registration & Emergency Information

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* 1. Which program are you registering for?

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* 2. Youth Name

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* 3. Date of Birth

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* 4. Name of School Attending

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* 5. Parent/Guardian/Caregiver/Homestay Name and address

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* 6. Phone Numbers

Home

Work

Cell

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* 7. Emergency Contact Information (if different than above)

Name

Address

Phone Number

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* 8. Youth Allergies/Food Sensitivities

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* 9. Medications

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* 10. Physical limitations, learning and/or behavioural challenges