Saturday, May 27, 2017
Name of Youth to be Registered:
Parent/Guardian's Name:
Parent/Guardian's Cell or Work Number
Parent or Guardian's Email:
Parent or Guardian's Home Phone:
Youth's Age:
Youth's Grade in January 2017:
Member of UBC?:
If no, Name of Church Home:
Emergency contact:
Emergency contact's phone:
Please list any allergies or other medical conditions:
Family Doctor's Name:
Family Doctor's Phone:
Sibling 1 attending name and age:
Sibling 2 attending name and age:
Sibling 3 attending name and age:
Sibling 4 attending name and age:
Will youth need transportation?:
Best time to Call:
Person who will drop off:
Person who will pick up:
Youth will attend (check all that apply):
Word Verification: