Youth Name *
Youth Name
Parent Name *
Parent Name
Phone Number *
Phone Number
(Home, work or cell)
Alternative Phone Number *
Alternative Phone Number
(Home, work or cell)
Address *
YES Media Release *
I give my permission for YES, its agents, employees, or students to take photos of the activities in which the above mentioned minor may be participating. Please note that program photos may be used in YES promotional materials (i.e. brochures, newsletters, press releases, slide shows, videos, television promos and Facebook page). By checking the box below you agree to these terms.