Registration - VALDEZ YOUTH COURT

VALDEZ YOUTH COURT

Registration for new Members

* Indicates required field

Name *

First

Last

Parent/Guardian Email *

Student Email *

Parent/Guardian Phone *

Parent/Guardian Name *

First

Last

Student Phone *

Student Date of Birth *

Student Gender/Pronouns *

Physical Address *

Line 1

Line 2

City

State

Zip Code

Country

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Dietary Restrictions (If any) *

Accomodation Requirements (eg Visual/Hearing/Learning etc) *

Current teams/after school activities *

Grade *

I agree to abide by Valdez Youth Court Confidentiality requirements at all times *

I Agree

I agree to act as a positive peer role model within my community *

I Agree

Submit