Banisters Summer Y2M/Night L.I.F.E  Registration 
Banisters Summer Sign-up Form
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Email *
Parents First and Last Name *
Parents Phone Number *
Address  *
Parents Email Address  *
Childs First and Last Name *
Childs Phone Number *
Childs Age *
Childs Grade  *
Childs Gender *
Childs Race *
City *
Child Allergies *
T-Shirt Size *
Are you eligible for Free or Reduced Lunch?
*
Does your child have an Individual Education Plan (IEP) for a physical, learning or emotional disability?
*
Is your child in foster care?
*
Does your child have a physical, mental, learning, emotional or behavioral disability?
*
Is  your child currently under the care of a doctor for any of the above disabilities?
*
Does your child currently or has  in the past used alcohol or illegal substances?
*
Is your child Currently employed?  *
Emergency Contact Name *
Emergency Contact Number  *
Summer Program Location *
Child Photograph Consent *
Can Your child be photographed and pictures used for our social media ?
Parent and Youth Agreement
*
All youth 18 and under must have parent/guardian permission to participate in Banister Leadership Academy Y2M Project. If you are 18 and under you can still complete the application today if your parent is not present, however, permission must be obtained before starting employment with Banisters Leadership Academy!
Required
* By entering my name below, I am agreeing to all of the above and consent to an electronic signature.
*
Date *
A copy of your responses will be emailed to the address you provided.
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