Online Forms

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5. Hinton Youth Centre: Youth Registration Form

   New to the Hinton Youth Centre? Welcome!

   We're located in the Dr. Duncan Murray Recreation Centre on the second floor (across from the cafeteria). Our hours are:

   - Tuesday to Saturday: 3:00 - 9:00 pm

   Our phone number is 780-865-6029. Please complete this form and reach out with any questions!

7. First Name*
8. Last Name*
10. Home Address*
11. Phone Number*
13. Age
    -- Select One --131415161718
14. Date of Birth*
    Date of Birth
16. Medical Information
    This information is confidential and will only be given to medical personnel in the event of a medical emergency.
18. Alberta Health Services (AHS) Number*
19. Medications (if any):
21. Special Needs (if any):
22. Allergies (if any):
24. Emergency Contact Information
    Please ensure parents are not listed as Emergency Contacts. Emergency Contacts will only be called when parents listed above are not available.
26. Contact #1 Name*
27. Contact #1 Relationship to Youth*
29. Contact #1 Phone*
30. Contact #1 Alternate Phone
32. Contact #2 Name*
33. Contact #2 Relationship to Youth*
35. Contact #2 Phone*
36. Contact #2 Alternate Phone
38. Parent/Guardian Information
    Please provide the contact information for at least one parent or guardian.
40. Parent #1 Name*
41. Parent #1 Address*
43. Parent #1 Phone*
44. Parent #1 Alternate Phone
46. Paren #2 Name
47. Parent #2 Address
49. Parent #2 Phone
50. Parent #2 Alternate Phone
52. If you would like to sign up for our mailing list to stay up-to-date on Youth Centre info through email, please provide your email address below:
54. Final Step!

    The LAST thing you need to do is get a "registration sign-off" sheet from the Youth Centre and have your parent/guardian sign it, then return it signed to the Youth Centre staff. 

    We're so excited to welcome you to our Youth Centre! Thanks for registering with us!

Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field