Cheer Crew | Northumberland Youth Unlimited

Youth Information

Youth Name*

First Last

Date of Birth*

DD

MM

YYYY

Gender*

Female
Male

Allergies or medical conditions?

Program Selection

1. Select your preferred Cheer Crew option.

- IN PERSON AT THE CCC: All individuals ages 12+ must be fully vaccinated with proof. All individuals under age 12 are vaccine exempt at this time.

- WATCH PARTY: Our office has been designated an essential service venue, therefore a vaccine certificate is not required.

2. Sign up for our Bag & Rake afternoon with the Cougars players (Oct. 30 1-4pm).

Program Selection*

In person at the Cobourg Community Centre
Watch Party at our office (beside the CCC)
Bag & Rake Day (Oct. 30 1-4pm)

Guardian & Home Info

Parent/Guardian #1 - Name*

First Last

Parent/Guardian #1 - Email*

Parent/Guardian #1 - Cell Phone*

Parent/Guardian #2 - Name

First Last

Parent/Guardian #2 - Email

Parent/Guardian #2 - Cell Phone

Home Address*

Street Address Address Line 2 City Province Postal Code

Home Phone (if not a cell phone)

Consents

PARTICIPATION: I give permission for the youth in my care noted above, to attend and participate in this program set forth by Northumberland Youth Unlimited (YFC). These programs include and are not limited to: in person events and online programs.*

Yes, I give permission.
No

MEDICAL/PERSONAL HARM: I give permission for the person(s) in charge to seek medical assistance for the youth in my care noted above in the event of accident or injury. Furthermore, I agree to not hold Northumberland Youth Unlimited (YFC) or any of its subsidiary programs, staff, volunteers, directors or officers responsible for any harm that may occur to the youth in my care noted above as a result of his/her wilful participation in the event or program.*

Yes, I agree.
No

PHOTO/VIDEO: I do authorize Northumberland Youth Unlimited (YFC) to take, use and own, in perpetuity; photographs or video/audio recordings of the youth in my care noted above, understanding that these may be used for public promotional purpose. Northumberland Youth Unlimited does not sell or give away any recorded materials or personal information.*

* Note: Names will not be used at any time.

Yes, I authorize.
No

SIGNATURE: I acknowledge that clicking on the SUBMIT button below serves as my legal signature.*

Yes, I acknowledge.
No

Name

This field is for validation purposes and should be left unchanged.

Cheer Crew Registration

Youth Information

Program Selection

Guardian & Home Info

Consents