CAST Registration

    Youth Information











  • Participation Permission

  • By checking the box below, I give permission for my child to participate in the CAST.
  • Photo/Video Permission

  • By checking the box below, I give permission for my child I give permission for my child to be photographed and/or videotaped within the context of the CAST. I also give permission for PCYC to use
    any photograph/video segment for the purposes of advancing the mission of the organization.
  • Phone Numbers, Email, Emergency Contact

 

Health Information

    Clinic/Physician Information

  • Medical Information

  • Does your child have:

  • By checking the box below, I give permission for my child to be seen for health services in the clinic at Plymouth Christian Youth Center and give permission for staff to transport my child to receive emergency medical attention if needed.

 

Verification