Youth Enrollment Form Youth Name Address City, State & Zip House Phone ?Please enter your home phone number. If you do not have a home phone, please type NA. Youth Cell Phone Number ?Please enter the cell phone number for the Youth enrolling. If the Youth does not have a cell phone number, please type NA. Birth Date ?Please enter your birth date in the form dd/mm/yyyy. Age Grade ?Please enter the grade that you are currently in for school. Youth's School Name Youth's Email Address Parent's Name Dad's Contact Number Mom's Contact Number Dad's Email Address Mom's Email Address May we add your e-mail to our parents e-mail list? Yes No Areas of Interest Emergency Contact ?Please provide the name of someone that we can contact in case of an emergency. Emergency Contact Phone Number ?Please provide a phone number for your emergency contact.