Program Registration
First and Last Name *
Your answer
Preferred Pronoun
Your answer
Age *
Your answer
Gender *
Your answer
Cell Phone Number *
If you do not have a cell phone, please include an alternate phone number here, and note what type of phone it is. For example, Landline: 555-555-5555 or Mom's phone: 555-555-5555
Your answer
Email Address *
Your answer
Parent/Guardian or Emergency Contact Name *
Your answer
Parent/Guardian or Emergency Contact Phone Number *
Your answer
Parent/Guardian or Emergency Contact Email *
Your answer
Do you have any physical, emotional, or mental health considerations (including medications) that we should know about? *
Please note, this information will be kept confidential and will not affect our selection process. We just want to make sure that we can provide you with a safe and supportive experience. If you do not have any health issues, just write N/A.
Your answer
Do you have any food allergies or dietary restrictions? *
Your answer
Are you able to attend the full program? *
Required
Your parent/guardian will need to sign a Reel Youth media release form. *
Required
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