Youth Information

Name

Date of Birth

Email

Phone number

Address

Languages spoken
EnglishFrenchOther

Parent/Guardian Information

Name

Email

Phone number

Acknowledgement

My parent/guardian has given me permission to complete this registration and I understand that Makria Youth Centre of Excellence may confirm this to ensure my eligibility.

I accept

Program Needs

Please select factors in the program that are relevant (Select all that apply)

I would like to be a member of the organizationI am interested in youth programsI am interested in becoming a community leaderI would like to speak with other team leaders

Are you currently a member of another youth organization? If so, please state the name of the organization.

Policies

• I agree that I am responsible for my own behaviours and actions while attending Makria Youth Centre of Excellence.

• I release Makria Youth Centre of Excellence from all responsibility in respect of any injuries.

• Should I have a concern regarding the quality or access in any of the Youth Programs/Events, I can email the Executive Director at director@makria.org or call 289 339 9575 between the hours of 10:00 am to 6:00 pm.

I acknowledge the policies above

Photo Consent and Release

I, the parent/guardian, grant the permission of Makria Youth Centre of Excellence (MYCOE), to publish photos for external and internal stories, articles, video, audio footage of my children named in this registration form. I understand that MYCOE will use this material in marketing, publications, advertising, communications on the internet now and for the future. All materials approved will remain exclusive property of MYCOE, and may be reproduced by MYCOE, as well as others authorized, without compensation or payment to the individuals concerned or any other person.

Yes, I consentNo, I do not consent. Please do not take photos of my child.

Confirmation

I confirm that all the information of this form is (including family information and all individual child/youth information) is complete and correct. I confirm that I have read, understood, and agree to all the contents of this form. I agree that all parents and guardian(s) of the child/youth are in agreement with the contents of this form.
I confirm