Village FYRE Registration Form
Please fill out this form to register your student for Village FYRE Teen Night. Student will not be able to participate if consent form isn't completed.

Date: July 30, 2021
Time: 5:30-9:00p
Location: Linwood YMCA, 3800 East Linwood Blvd, KCMO 64128
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Email *
What is your name? (first, last) *
What is your student's name? (First/Last) *
Home Address? *
Phone Number: *
Emergency Contact Name: (Different than your own) *
Emergency Contact Number? *
What size T-shirt does your student wear? *
What school does your student attend? *
What grade is your student in? (2021-2022 school year) *
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