Youth Connection Emergency Contact Form

Please note: This form is for the 2016-2017 school year ONLY. If you would like to participate in Youth Connection Programming for the 2017-2018 school year, the new Emergency Contact Form will be available in early August 2017.

Emergency Contact Form 2016-17

    Check all that apply.
  • Please do not provide the child's email but an email where we can reach a parent.
  • Please list any allergies the participant has. If none, please type NONE.
  • Please indicate any medications the participant takes regularly. If none, please type NONE.
  • Is there any other information we should know about the participant including any special needs or supports.