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SEMC Senior Youth Registration Form
2023/2024
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* Indicates required question
Name - Child #1
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Grade
*
Your answer
Name - Child #2
Your answer
Birthdate
MM
/
DD
/
YYYY
Grade
*
Your answer
Address
*
Your answer
City
*
Your answer
Postal Code
*
Your answer
Home Phone #
*
Your answer
Cell Phone #
*
Your answer
Is the number provided above:
Parent's cell phone
Child's cell phone
Clear selection
Email
*
Your answer
Parent's Names (if under 18 years of age)
*
Your answer
Emergency Contact (if under 18 years of age)
*
Your answer
Allergies and/or any other information we should know about your child.
Your answer
I permit photos and videos to be taken of my child(ren) and displayed at SEMC.
*
Yes
No
I permit photos and videos to be taken of my child(ren) and displayed on media channels such as SEMC's website, Facebook, Twitter, Instagram, etc.
*
Yes
No
My child(ren) has permission to attend and participate in SEMC's Youth Program.
*
Yes
No
Not Applicable
Parent's Signature
*
Your answer
Submit
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