Youth Connection Emergency Contact Form

Please fill out the information below prior to the participants first day at RAD/ the DEN/ Homework Club.

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.