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Youth Program Club Membership
Jane and Finch Community
2023/24 School Year
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* Indicates required question
Participant (youth) information
First Name
*
Your answer
Last Name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Email address
Your answer
Medical Information
Health card number
Your answer
Doctor's name
Your answer
Doctor's phone number
Your answer
Allergies/Limits to participation
Please indicate any accommodations required or limits to participation.
Your answer
Program information
School
*
Your answer
Parent/Guardian #1
First and last name
*
Your answer
Email address
*
Your answer
Primary Phone number
*
Your answer
Secondary Phone number(s)
Your answer
Address
*
Your answer
Postal Code
*
Your answer
Parent/Guardian #2
First and last name
Your answer
Email address
Your answer
Primary Phone number
Your answer
Secondary Phone number(s)
Your answer
Leave parent #2 address blank if it's the same as parent #1
Address
Your answer
Postal Code
Your answer
Emergency Contact
Other than a parent/guardian - we will always attempt to reach the parents/guardians first
Name
*
Your answer
Relationship to the participant
*
Your answer
Primary phone number
*
Your answer
Secondary phone number
Your answer
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