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Youth Registration
Contact us at 267-768-7738 or Email us at
Info@kidzindahoodinc.com
We are excited for you to be apart of our community!
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* Indicates required question
Youth Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Your answer
Nationality
Your answer
Parent/Caregiver Name
*
Your answer
Email
*
Your answer
Grade
*
Your answer
School
*
Your answer
Youth Phone
*
Your answer
Parent Phone
*
Your answer
Address
*
Your answer
Emergency Contact
*
Your answer
Do you require transportation?
*
Yes
No
Required
Dietary restrictions/Allergies
*
None
Vegetarian
Vegan
Kosher
Gluten-free
Other:
Activities/Events you would like your youth to participate in:
*
Teen Summit
Monthly Workshops
Community Service
Teen Socials
Mentorship
All
I understand that pictures may be taken during events/activities within the program and can be used for media purposes (brochures, social media, etc)
*
I give consent for my youth's picture to be taken/used for media purposes
I do not give consent for my youth's picture to be taken/used for media purposes
Required
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