Register with F.O.C.U.O.S.

Complete The Participant Registration Form Below:

PARTICIPANT INFORMATION

Participant Profile Picture

Participants First Name

Participants Last Name

Youth Phone

Date of birth

Age

Gender

Select

Male
Female
Other
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Current School

Grade

T-Shirt Size:

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Participant Photo

Home Address:

Address

Street Address

City

State

Postal code

PARENT/GUARDIAN INFORMATION

Parents/Guardian Name

Relationship to Youth

Phone

Secondary Emergency Contact:

Emergency Contact Name

Relationship

Emergency Contact Number If Guardian Cannot Be Reached

MEDICAL INFORMATION

(Used only for emergency purposes)

Does the Participant have allergies?

Yes

Provide Allergies (Food, Medication, Environmental): If Above answer is Yes

Medications Taken Regularly: if applicable

Medical Conditions or Special Needs:

Doctor's Name

Doctor's Phone:

PROGRAM DETAILS

Which program(s) are you enrolling in? (Check all that apply)

After-School Program

Mentoring Program

Summer Program

Leadership Workshops

Community Events

Tutoring / Academic Support

Sports / Recreation

Other

Preferred days of participation (if applicable):

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

PERMISSIONS & AGREEMENTS

Photo/Video Release

I give permission for my child to be photographed or recorded for program documentation, marketing, or social media.

I do not give permission for my child to be photographed or recorded for program documentation, marketing, or social media.

Transportation Permission

I give permission for my child to be transported by program staff or authorized vehicles.

I do NOT give permission.

Emergency Authorization

I authorize program staff to secure medical treatment for my child in the event of an emergency when I cannot be reached.

HOUSEHOLD INFORMATION (Optional but helpful for reporting & funding)

Number of Family Members in Home

Annual Household Income Range:

Under $25,000

$25,000–$40,000

$40,000–$60,000

$60,000–$80,000

Over $80,000

Prefer Not to Answer

HOW DID YOU HEAR ABOUT US?

School

Social Media

Friend/Family

Community Event

Flyer

Other

PARENT/GUARDIAN FINAL SIGNATURE

I certify that the information provided is true and accurate. I agree to support my child’s successful participation in the program.

Printed Name

Today's Date

Parent/Guardian Signature

Clear