Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Name of Parent *

First Name

Last Name

Parent's Phone *

(###)

###

####

Photos may be taken of events and activities that your junior youth participate in with the group. Do you give permission for these photos to be used as promotional material for the JYSEP program? *

Yes

No

As part of the Junior Youth Empowerment Program's commitment to provide your junior youth with a safe environment and in keeping with our risk management and duty of care policies, the following agreement needs to be signed: I understand that JYSEP will endeavour to provide for my junior youth a safe environment. In the case of personal injury, loss or damage, I, or a third party, will not hold the JYSEP and its agents and volunteers responsible. *

I agree