Registration Form

Please select the progam
Child Information:
Is your child on an Individual Education Plan (IEP) for Language?

If yes, please provide us with a copy of their IEP or a similar document

"If you do not have an up to date copy of your child's IEP report, please bring it in person to class."
Parent / Guardian's Information:
Emergency Contact Information
Parent's Consent

I hereby grant permission to Youth and Parents Association of Markham (YPAM) to release the above information to a medical practitioner in case of emergency. The child will be taken to the nearest hospital for examination and, if necessary, x-rays. Moreover, this information will be shared with the transportation carrier.

By signing below, I acknowledge and irrevocably give consent to the Youth and Parents Association of Markham for the following:

Acknowledgement of Parent / Guardian Responsibility of Child`s Safety : I understand that I am responsible for picking up my child from the Youth Leadership Program (YLP) promptly at the end of my child`s YLP session. I acknowledge that if I am unable to pick up my child, then I am responsible for making arrangements to have my child picked up at the end of their YLP session. I acknowledge that it is my responsibility to notify the program supervisor of the arrangements in writing. My signature below acknowledges that I, and not the Youth and Parents Association of Markham, am responsible for the safety and well-being of my child once their YLP session has ended.

Photo / Video Release Consent: Youth and Parents Association of Markham and other affiliated organizations have permission to take and use photographs and/or video of my child taken during the event. I acknowledge that photographs and/or video taken at the event may be used for fundraising, publicity and/or other purposes to market the organization and its goals. This may include, but is not limited to, print and publications, social media, press releases, funding applications and the organisation`s website. I understand that it is my responsibility to notify Youth and Parents Association of Markham in writing in the event that I no longer wish to authorize the above uses. I acknowledge that no royalty fee or other compensations shall become payable to me for reason of such use. My signature below acknowledges that I understand and agree to the conditions outlined in this statement.

Food Allergy / Allergy Consent: Youth and Parents Association of Markham and its affiliates are not responsible nor accountable for any allergic reaction my child may experience during an event. I also understand that the Youth and Parents Association of Markham and its affliates are not responsible for providing any medication or shots to my child. I acknowledge that I am responsible and accountable for the food handling for my child. My signature below acknowledges that I understand and agree to conditions outlined in this statement and take full responsibility for my child`s well-being.

Payment