Youth Registration Form Youth Registration Form Enrollee InformationMedical InformationOther Emergency ContactOCFY Required InfoNotesConsent/Release form(s) If you are human, leave this field blank. ENROLLEE INFORMATION Info Youth Name * First and Last Date of Birth * Date of Birth Age Age Grade School Name * Aurum Prep Academy Allendale Elementary REACH Academy Elementary Carmen Flores Claremeno Community Charter School East Oakland Pride (EOP) Elementary La Escuelita Edna Brewer Franklin Kipp Bridge Manzanita Seed Other School Name Parent 1 Name: First and Last P1_Relationship Mother Father Legal guardian Other P1_Relationship Relationship to Youth Parent 2 Name: First and Last P2_Relationship Mother Father Legal guardian Other P2_Relationship Relationship to Youth Address Street Apt Apt City City State CA AK AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY State Zip Zip code Youth Info Cell Phone Youth Email Email Parent 1 Info Cell Phone Parent 1 Email Parent 2 Info Cell Phone Parent 2 Email Email Preferred way to contact: phone email mail Next: Medical Information
