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Online Activity Registration Form
If the participant is a minor a parent/guardian must complete this form.
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* Indicates required question
Email
*
Your email
PARTICIPANT'S INFORMATION
Participant's Full Name
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Address (include zip code & apt # if applicable)
*
Your answer
Participant's E-Mail Address
*
Your answer
Participant's Cell Phone
*
Your answer
Gender Identification (as some of our activities are funded by federal grants we are required to ask this)
*
Female
Male
Other:
Race/Ethnicity: Please check all that apply (as some of our activities are funded by federal grants we are required to ask this)
*
Asian
American Indian
Black
Hispanic
White
Other Multi-Racial
Required
FAMILY INFORMATION
If the participant is a minor this section must also be completed.
Primary Guardian Name
Your answer
Primary Language
Your answer
Home Address If Different From Child (include zip & apt # if applicable)
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Primary Guardian E-mail
Your answer
Confirm E-mail
Your answer
How did you hear about us? Please check all that apply.
*
Friend
School
Big Brothers & Big Sisters
Facebook
Instagram
Jersey City Spring Sports Expo
Other:
Required
Participant Agreement & Media Release (link below)
https://drive.google.com/file/d/1Zl5i_DYj5UHS-fPNM_4nGrPv4mpDUW28/view?usp=sharing
Have you read and agree to the participant agreement and media release?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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