Dare to Draw Registration Youth InformationYouth Name* First Last Gender* Female Male Date of Birth* Day Month Year Age as of Oct. 19, 2021*ages 10-15Please enter a number from 10 to 15.Allergies or medical conditions? Guardian & Home InfoParent/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 PhoneHome Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone (if not a cell phone)ConsentsPARTICIPATION: 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.* Yes, I agree. No PHOTO/VIDEO: I do authorize Northumberland Youth Unlimited (YFC) to take, use and own, in perpetuity; names, 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 do not sell or give away any recorded materials or personal information.* Yes, I authorize. No SIGNATURE: I acknowledge that clicking on the SUBMIT button below serves as my legal signature.* Yes, I acknowledge. No NameThis field is for validation purposes and should be left unchanged.