Registration — Your Site Title

Kids Club

REGISTRATION FORM

Please fill out the needed information below.

Name required of child

First Name

Last Name

Birthday

YYYY

Age

Gender

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

EMERGENCY CONTACT

Emergency contact email:

Emergency Contact Phone

(###)

###

####

Allergies or dietary restrictions

PHOTO / VIDEO RELEASE

YQG Kids may have an opportunity to receive exposure from various media outlets such as TV or newspaper as well as social media platforms As well, YQG Kids may produce publications of its own to raise funds and awareness for the programs we are able to provide for the children. It’s important for us to ensure the privacy of each of the children in our care, therefore we require a signature from a parent or guardian to grant permission for your child’s photo to be taken.

Kids Club

REGISTRATION FORM

Info

YQG Kids