Youth Registration Form

Parent Information Form

Date

Father's First Name

Father's Last Name

Mother's First Name

Mother's Last Name

Street AddressHome Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

PhoneFather's Phone Number

Father's Email Address

PhoneMother's Phone Number

Mother's Email Address

Who referred your child/children to the OMYGA Program?

Method of Payment

Payment MethodCheckCash

Amount

Total Amount Paid

Balance

Registration Form - 2025

Registration Fee - $250 per Student

Field Group

Student's Name

Student Birthdate

Student Age

Gender/SexMaleFemale

Current School Attending

Grade

List Physical Limitations

Physician's Name

Physician's Phone Number

MEDICAL RECORD ON FILE?

Parent Consent Form - 2025

Youth to Participate

Youth Name

Date of Birth

Youth Age

Youth Name

Parent Contact Number

Today's Date

OMYGA Student Liability Form

2025

Youth Name

Date of Birth

Student Agreement Form

OMYGA 2025

Medical Information Sheet

Father's Name

Father's Phone Number

Mother's Name

Mother's Phone Number

Additional Contact's Name

Additional Contact's Phone Number

Additional Contact's Name

Additional Contact's Phone Number

Doctor's Name

Doctor's Phone Number

Fainting episodes during exerciseYesNo

EpilepticYesNo

Trouble breathing during exerciseYesNo

AsthmaYesNo

DiabeticYesNo

If Yes to DiabeticType 1Type 2

Heart ConditionYesNo

Medication. Please List BelowYesNo

Wears a Medical Information Bracelet/Necklace? Please Explain Purpose BelowYesNo

Allergies. Please List Below.YesNo

Medications

Allergies

Any information not covered above

Pants & Shirt Sizes

OMYGA 2025

Youth Sizes

Youth First Name

Last Name

Date of Birth

Youth Shirt Size

Youth Pant Size

Office

Links

Newsletter

(321) 436 - 6667