+905 862 3456
Youth Registration Form
If you are human, leave this field blank.
Date of Birth
Primary Contact (Parent/Guardian)
Primary Contact Phone #
Secondary Contact (Parent/Guardian)
Secondary Contact Phone #
Health Card #
Physician Phone #
I hereby grant permission to The Uxbridge Youth Centre Inc. to use photographs taken of my child during UYC drop-in hours, programs and events to be used for the purpose of online, print and video based marketing materials.
I give permission for my child to participate in Uxbridge Youth Centre programs and events. I understand that activities may involve certain risks of physical activity and possible injury and that staff and volunteers will provide each participant with reasonable care, but that the UYC cannot guarantee that my child will remain free of injury. I nevertheless wish to have my child participate and I ASSUME the RISK of his/her participation. I agree to RELEASE from LIABILITY, INDEMNIFY and HOLD HARMLESS the Uxbridge Youth Centre and its staff, volunteers, and board, and the Township of Uxbridge from any and all claim and/or cause of action arising out of and related to my child's participation in this program/event.
What We Do
The UYC provides drop-in hours and relevant programs for all youth ages 11 and up in a positive, inclusive environment.
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75 Marietta Street Uxbridge, ON L9P 1K4
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