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Dunnville Youth Impact Centre Summer Programs 2026 Participant Registration
When: Programs will take place from July 7th - August 28th, 2026
**Please note you do not need to pre-register for Tuesday Family Brunch or Wednesday Youth @ Lion's park**
Contact us at  289-769-0226 or youthimpactcentre@gmail.com
Website: www.youthimpactcentre.com

* Every participant must have their own form - but can register for multiple programs *
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Email *
I am registering for: *
Required
If applicable, for the Monday camp please let us know if there is 1 other registered participant your child would like to be in the same group as. Name them below or type N/A *
Participant Name (First & Last) *
Participant Email (If applicable. If not please type N/A) *
Date of Birth *
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DD
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YYYY
Address *
Home Phone *
Parent/Guardian Email *
Emergency Contact Name *
Emergency Contact Relationship to Participant *
Emergency Contact Phone # *
Any allergies, dietary restriction or medical conditions that we should be aware of? *
Is your child bringing any medication with him or her? (Antibiotics, ventilator, epipen, Ritalin) Please note YIC staff or volunteers will not be responsible for giving or applying any medication *
If your child will be bringing medication, please explain *
Does your child have any physical, emotional, mental or behavioral concerns or limitations that our staff should be aware of? *
Do you give the Dunnville Youth Impact Centre permission to use pictures of your child for display (ie- on our website, flyers or social media?) *
By typing your name, you agree to having your child participate in the above mentioned programs. Precautions are taken for the safety and health of your child, but in the event of accident or sickness, Dunnville Youth Impact Inc. , the board, employees and volunteers are hereby released from any liability. In the event that your child requires special medication, x-rays or treatment, the parents/guardians will be notified immediately *
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