Youth Training Academy Registration
Fill our this form to register your child in WCDI's YTA
Email address *
Date and Age Group
Student's First Name *
Your answer
Student's Last Name *
Your answer
Gender *
Date of Birth *
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/
DD
/
YYYY
Grade in School *
Parent or Guardian First Name
Your answer
Parent or Guardian Last Name
Your answer
Emergency Contact Phone Number
Your answer
Student Pertinent Medical Information (allergies, medication, etc.)
Your answer
Any additional info you would like us to know?
Your answer
I understand in the event of an emergency my child will be rushed to Columbus Regional Hospital. WCDI will contact the parent or guardian if any issues arise by the emergency contact phone number. *
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Watson Chambers Defense Institue.