DUUF High School Youth Group Registration Form

Please complete a separate form for each student.

Student Information

Name

*

Pronouns

Birthdate

*

Grade

*

Please select one option.

No Grade Pre-Kindergarten Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Graduated

Parent/Guardian Information

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

Additional Information

Please share any information we need to know about your student including allergies, mobility, medications, dietary needs, etc. You may want to include special education needs (emotional or cognitive), behavioral management startegies, family dynamics, or anything else that would help us better support your student.

Allergies

Medical Conditions

Medications

Other Information

Vaccinated for COVID-19

*

Please select all that apply.

Yes No

Emergency Contact Information

Name (Emergency contact 1)

Cell phone (Emergency contact 1)

Home phone (Emergency contact 1)

Name (Emergency contact 2)

Cell phone (Emergency contact 2)

Home phone (Emergency contact 2)

Photo Release

I give permission for my child's picture to be used on:
(Check all that apply.)

Photo Release

Please select all that apply.

Bulletin board in classroom Youth group website DUUF website Social Media (public DUUF page and closed DUUF community group)

Description

Please complete a separate form for each student.

Please Fix the Following

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