New Registration Form 2015
Youth in Motion is Hawaii non profit organization....

"Empower, Equip, Educate, Challenge and Motivate Youth through activities that engage and develop their mental, emotional, creative, and physical skills on the land and in the ocean."
Registration Date *
Please use this format ..Month/Day/2011
Name *
Birthdate *
Please use this format 06/26/2000
Age as of registration date *
Ethnicity *
Required
Place of Birth *
Parents/Guardians Name
Physical Address
Mailing Address *
District/Town/Country of Residence
ie where do you live and call home
Home Phone Number *
Cell Number
Emergency Contact and Phone Number *
email: *
Name of School/college
Activities that interest you
So we know a little more about you...
Yim activities of interest *
Required
Waiver signed *
Required
Parents/Guardian signature *
Please print out this page and sign below and send hard copy to Youth In Motion
Youth In Motion waiver
please sign this
Submit
Never submit passwords through Google Forms.
This form was created inside of Youth In Motion.