YMATC Membership & Registration Information
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Email *
Student's LAST Name *
Student's FIRST Name *
Student's MIDDLE Name(s)
Best Phone Number *
Gender *
Age
Date of Birth *
MM
/
DD
/
YYYY
Grade in School *
Complete Mailing Address (#, Street, city, prov, postal code) *
Parent/Guardian Name (First and Last) *
Relationship to Student *
Emergency Contact OTHER THAN PARENT (name & phone) *
Which program(s) is this student trying for free? OR Training in (Check all that may apply) *
Required
Medical/ Physical Info Pertinent to Training (Asthma, Hemophilia, allergies, ADHD, Autism, Palsy, previous injuries, previous surgeries, etc. OR N/A) *
How did you hear about YMATC? (Social media, refer a friend, etc) *
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