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MYTHIRDPLACE Teen Registration
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* Indicates required question
Teen First Name
*
Your answer
Teen Last Name
*
Your answer
Teen Gender
*
Female
Male
Other:
Teen Date of Birth
*
MM
/
DD
/
YYYY
Teen Cell Phone
Your answer
Teen Email
Your answer
School
*
Your answer
Grade 2020-2021 School Year
*
Choose
6th
7th
8th
9th
10th
11th
12th
Can your child walk home from MYTHIRDPLACE (777 E. Alosta Ave.)?
*
Yes
No
Are you comfortable with your child engaging in in-person activities or events with proper masks and physical distancing?
*
Yes
No
Allergies
Your answer
Medical Conditions & Medications
Your answer
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