Junior Youth Activity Day

Monday August 26th 2024

11:30 AM to 3:30 PM

1532 Prairie Avenue, Port Coquitlam

Open to all 11 to 14 year olds!

Please fill out the registration below.

Name of Junior Youth

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone

(###)

###

####

Address

Does your junior youth have any allergies, dietary, illness, disability or other medical conditions?

Emergency Contact - Name, Relationship, Contact

Do you permit the use of the photos and videos taken of the camp's activities that include your son/daughter, to be used in the program's promotional materials?

This event is open to all! Please provide the names of any friends you would like to invite: