ANEW BAM Youth Registration
Student Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Grade For Fall 2017 *
Gender *
School *
Your answer
Home Address
Your answer
Mailing address if different from home address *
Your answer
Parent Name(s) *
Your answer
Parent(s) Email Address *
Your answer
Parent Phone Number(s) *
Your answer
Diet Restrictions?
If 'YES', List Restrictions Below
Your answer
Health conditions
Your answer
Photo permission *
Do you grant ANEW BAM permission to use your child’s picture/video in any promotional literature that may be required?
Field Trip *
I give permission for my child to participate and/or be transported by ANEW BAM to special events and field trips. I understand that I will be notified about special events (field trips) prior to the date.
Emergency Contact infomation *
Please provide the contact information for a parent/guardian who can be contacted in case of an emergency if you are unavailable.
Your answer
How will your child get home from programing?
Pick Up Authorization
List the name(s) If for any reason your child would need to be picked up from the program by someone other than a parent/guardian.
Your answer
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