2019 Youth FX Summer Registration Form

DATE: Monday, July 8th - Friday, August 9

TIME: 10am-4pm

LOCATION: Youth FX Studio

25 Warren St. Albany, N.Y. 12202

(btwn. Phillip & Grand St.)

Albany, NY 12202

If you have any questions, please contact us at: info@youthfx.org

Student Name *

Student Name

First Name

Last Name

Email *

Please provide an email address that we can reach you at. Our goal is to stay in touch even after Youth FX Summer has ended.

Phone *

Phone

Please provide a phone number that we can reach you at throughout the summer and afterwards.

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SOCIAL MEDIA

We will be posting regularly on social media throughout the 5 Weeks of Youth FX. Please share any social media you have below to be tagged in our posts.

Facebook

Instagram

Twitter

HEALTH | WELLNESS

Please list any allergies you may have.

Although we will not be serving lunch on site, we will be offering snacks and would like to be aware of any allergies to lower the risk of an allergic reaction.

Is there anything else you would like to know?

Accessibility Needs

Do you have any accessibility needs? If so please list them below.

PARENTAL INFORMATION

Parent Name *

Parent Name

First Name

Last Name

Phone *

Phone

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Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Email

EMERGENCY CONTACT

Please list an emergency contact that is not your parent.

Emergency Contact *

Emergency Contact

First Name

Last Name

Relationship *

Emergency Phone *

Emergency Phone

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Email *