2019/20 Fernie Mountainside Community Youth Group Registration Form
Welcome to Youth Group! We are so glad you are interested in signing up. Here's how you can get started:

- The safety of your child is our primary concern so please fill out one registration form per teen attending Youth Group.
- A physical copy waiver for the year will need to be filled out. The waiver will be available to fill out in person at youth nights, or can be printed off by clicking on the link below and brought to youth group

https://drive.google.com/file/d/1WEJYi0yyafre48w0-OkqGkTpQER5hEFZ/view?usp=sharing

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Email *
YOUTH INFORMATION
Last Name *
First Name *
Youth Email Address
Youth Cell Phone #
Home Phone # *
Instagram
Age *
Date of Birth *
MM
/
DD
/
YYYY
School Grade *
Gender *
Allergies, food sensitivities or medical/behavioural concerns? *
Health Card # *
PARENT INFO
Parents / Guardian Name(s) *
Primary Phone Number *
Secondary Phone Number *
EMERGENCY CONTACT INFORMATION (if parent/guardian is not available)
Name *
Relationship to Child *
Phone Number *
MORE INFO
How did you hear about Youth Group? *
A copy of your responses will be emailed to the address you provided.
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