YAK Youth Centre Program Registration 2025
 YAK Youth Centre Registration, Permission & Agreements. To be filled out by parent or guardian.
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Email *
YOUTH PARTICIPANT INFORMATION
Please tell us about your child/dependent.
Name of Participant (First and Last) *
Date of Birth *
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Current School Grade *
Current School *
Youth Participant Primary Township of Residence
(Check all that apply if your child/dependant shares residence in more than one township).
 *
Required
How does your child/dependant get along with others? Are there any specific social challenges we should be aware of? *
HEALTH & SAFETY
Does your child/dependant have any allergies? YES or NO (if you answer YES, please provide details)  *
Does your child/dependant have any mental or physical health conditions we should be aware of?  YES or NO (if you answer YES, please provide details)  *
Does your child/dependant take any medication we should be aware of? YES or NO (if you answer YES, please provide details)  *
PARENT(S)/GUARDIAN(S) CONTACT DETAILS
Indicate one or multiple primary parent details below.
Name(s) (First and Last), Relationship to Child/Dependant *
Home Address(es)
 *
Cell Phone Number(s) *
Home Phone Number(s) *
Work Phone Number(s) *
Email Address(es) *
ALTERNATIVE EMERGENCY CONTACT
Name (First and Last), Relationship to Child/Dependant *
Primary Phone Number *
Alternate Phone Number
AGREEMENTS AND PERMISSIONS
Permission for Child/Dependant to Leave Premises  *
Participants are responsible for managing transportation* to and from YAK Youth Centre, and signing themselves in and out. Participants may leave YAK Youth Centre at their discretion. If your child/dependant is required to stay on YAK premises for the duration of the program, please indicate below:

*YAK Youth Services offers shuttle transportation (weather permitting) TO YAK Youth Centre from St. John's HS (2:10) and PDCI HS (2:20) on days of operation. 
First Aid Agreement *
Do you give consent to YAK staff or volunteers to administer first aid to your child/dependant in case of emergency?
Code of Conduct Agreement *
I understand that YAK Youth Services has a Code of Conduct in place so that everyone who visits YAK Youth Services and YAK Youth Centre feels safe.

YAK Youth Centre participants must read and sign our Code of Conduct. Any youth, staff, or community member who violates this Code of Conduct is subject to dismissal.

You can find a copy of our Code of Conduct YAK Youth Services Code of Conduct here: https://yakyouth.ca/about-yak/
Liability Agreement *
By providing consent to participate in YAK Youth Services activities, the parent/guardian and your child/dependant assumes all risks associated with the activity and releases YAK Youth Services, its respective officers, staff and volunteers from liability in claims of injury or property loss/damage as a result of your child/dependent’s involvement in the activities.
MEDIA RELEASE *
I give YAK Youth Services the right to use photographs, videos or recordings of myself or my child/dependent for the purpose of promoting YAK through printed materials, media releases and social media. I understand that my identity of the identity of my child/dependent may be revealed.

I agree that YAK may use this material in print or electronic form, publicly or privately. I release YAK from any claims and demands in connection with the use of this material for the purposes mentioned above. I understand that I will not receive and financial or other remuneration for allowing YAK to use this material.

I confirm that I have read this agreement, fully understand its contents, and am agreeing to this voluntarily.
Today's Date *
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