Kenton Youth Registration Form

Name of Child(Required)

First Last

Date of Birth(Required)

Gender

Name of School

School Year

Address

Street Address Address Line 2 Town/City Post Code

Phone

Child's Email

Parent/Guardian's Email(Required)

Ethnicity

Please let us know of any particular needs or access requirements they may have so we can best support your child. (These details may include, but are not limited to, Anxiety, Autism, Dyslexia.)(Required)

Please note any medical information, conditions or allergies we should be aware of:(Required)

Emergency Contact Information

Contact 1: Name(Required)

Contact 1: Phone(Required)

Contact 1: Relationship(Required)

Contact 2: Name(Required)

Contact 2: Phone(Required)

Contact 2: Relationship(Required)

Permissions and Agreements

Name(Required)

First Last

I am a

Parent

Guardian

Photography Permission(Required)

I give permission for my child to be photographed or filmed.

I do not give permission for my child to be photographed or filmed.

Walk Home Alone(Required)

I give permission for my child to walk home alone after their session.

I do not give permission for my child to walk home alone after their session.