NEW LIFE SOUTH COAST

YOUTH CHECKIN

YOUTH INFO

Youth First Name

Youth Last Name

Birthdate

MM

DD

YYYY

Youth Phone

if applicable

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Please list any allergies or health concerns

PARENT INFO

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone

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Parent/Guardian Email

EMERGENCY CONTACT INFO

Emergency Contact's First Name

Emergency Contact's Last Name

Emergency Contact's Phone

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