Youth - Sign Up Yourself for IgNation

Please fill out this form and click submit. Questions? Contact youth@stig.ca.

Hi! Welcome to IgNation! If you have your own email address and cell phone number, you can sign yourself up here. If you don't have these, please ask a parent to use this form instead.

About You

Name

*

Email

*

This address will receive a confirmation email

Do you give us permission to email you?

*

Please select one option.

Yes No

Phone

*

Address

*

Gender

*

Please select one option.

Female Male

Please enter date of birth in Day-Month-Year format.

Birth Date

*

Grade in school, as of September 1, 2018?

Grade

*

Please select one option.

No Grade Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

Name of School

Family Information

Parent 1

*

Parent Email

*

Parent Cell Phone

*

Parent 2

Parent 2 Email

Parent 2 Cell Phone

Home Phone

Additional Information

Do youhave any allergies or medical issues? Do you carry an Epipen? (If no medical issues, please write "none.")

Medical Info

*

Photo release?

*

Please select all that apply.

I give permission. I do not give permission.

Photo or Selfie!

Upload Photo

Upload (8MB)

Notes

Sign Up Details

I am interested up for the homework program during Drop-in (4:00-5:00)

*

Please select one option.

Yes No I already did my homework, mom!

I am interested in signing up for the Dinner Program (5:30-6:30)

*

Please select one option.

Yes No From time to time. I will let you know.

Sweatshirt size (optional)

*

Please select one option.

Adult XS Adult S Adult M Adult L Adult XL (No sweatshirt, thanks)

Payment

IgNation + sweatshirt (175 CAD) IgNation only (150 CAD) I will pay on site by check or cash ((0) CAD) Please contact me about a bursary. ((0) CAD)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit. Questions? Contact youth@stig.ca.

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