Registration

Please complete the form below to register your child for the Junior Youth Empowerment Programme. Fields marked * are required. Your information is encrypted and only accessible to our team.

Junior youth participant

Tell us about the child you're registering.

First name *

Last name *

Date of birth *

Age *

Current school *

Current grade *

Home address *

Phone (if applicable)

English fluency *

Medical concerns (allergies, conditions, medications)

Emergency contact

Someone we can reach if we can't reach you.

First name *

Last name *

Relationship to participant *

Phone number *

Email *

Consent & additional information

Do you permit photos/videos of activities that include your child to be used (website, social media, brochures, posters, etc.)? *

Yes No

How did you hear about us? *

As parent/guardian of this participant I hereby give permission for my son/daughter to attend this event of the Junior Youth Empowerment Program (JYEP). I understand that JYEP will endeavour to provide my son/daughter with a safe environment. In the case of personal injury, loss or damage I, or a third party, will not hold JYEP, its agents or volunteers responsible.

Kindly type your name and date below and sign the hard copy provided by the animators.

I have read and agree to the statement above. *

Type your full name *

Date *