Parent/Guardian Info:

If you have more than one child in the program, you will have to complete the same form for each child. Each child must have their own registration form on file.

Date Completed

How many children under age 18 are you enrolling in the program?

First Name

Last Name

Relationship To Child

Phone *

Email *

Address

Street Address

City

State

Country

Postal code

Child's Emergency Contact Name (If Different)

Emergency Contact Phone

Emergency Contact Relationship

Does you child have reliable transportation to and from the program location?

How will they get to the program?

Are their any custody agreements or restrictions we should be aware of?

If you answered "YES" to the last question, please explain

Child's Information:

Child's 1st Name

Child's last name

Child's Date Of Birth

Child's Grade Level

School Currently Attending

T-Shirt size (for program events)

Does your child have any allergies, health conditions, or special needs? if "YES" please explain

Is your child currently enrolled in any other Youth programs, if so which ones?

Parents/Guardians must submit a copy of an unexpired government-issued ID (driver’s license, state ID, or passport) with this form.

I certify that all information provided on this form is true and accurate to the best of my knowledge.

I understand that submission of this form does not guarantee acceptance into the program, and that space is limited.

I agree to comply with Walkers Way Foundation policies and will support my child’s positive participation in all activities.

I understand that communication regarding the program will be shared using the contact information I provided above.

Parents Signature

Clear