High School Registration 2018-2019

To participate in our exciting High School activities, all youth must fill out our online registration form. Luckily--you need to fill out this registration form just once a year! Register now for all High School Activities for the 2018-2019 Program Year. Once you are registered, you WILL NOT receive a confirmation email. If you have any questions, please email Danielle at youth@hslckirkland.org.

Youth Name *
Youth Name
Address *
Address
Student Cell Phone
Student Cell Phone
Home Phone Number
Home Phone Number
Parent/Guardian 1 *
Parent/Guardian 1
Parent/Gardian 1 Cell Phone
Parent/Gardian 1 Cell Phone
Parent/Gardian 2
Parent/Gardian 2
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Cell Phone
Emergency Contact (other than parents) *
Emergency Contact (other than parents)
Emergency Contact Phone Number *
Emergency Contact Phone Number
I give my permission for my child to participate in these activities which will be led by Safe Haven trained adults. Please select all that apply. *
Please write your name below