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Youth Registration
Select Friday nights 7-9 pm
Contact us at (780) 875-8929 or
josiah@southridge.co
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* Indicates required question
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Your answer
Birthday/Grade
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Your answer
Name of Parent(s)/Guardian(s)
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Your answer
Email
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Your answer
Contact Numbers (Parents/Guardians)
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Your answer
Does your child have any Allergies/Medical Conditions/Medications/Special Needs that we should know about?
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Your answer
Family Doctor
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Your answer
Health Number
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Your answer
Emergency Contact (if parents/guardians are not available)
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Your answer
I give permission for my child to participate in onsite/offsite activities as a part of the Southridge Youth program. I give permission for transportation provided. I give permission for emergency medical treatment if required.
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Yes
Required
I give permission for photos to be taken of my child for use within Southridge Youth activities and/or to be posted on the Southridge Youth page.
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Yes
No
By typing my name in the box below, I give signed consent for my child to participate in Southridge Youth.
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