Youth Program Registration Form

Youth Program Registration Form

Use this online form to submit all the emergency and safety info for your child for our Youth Programs. You can also download a PDF version to print and send to ksantor@burlingtonvt.gov. Click here for the Medication Authorization Form 

Youth Program Registration Form

  • This form is valid for one calendar year (January 1- December 31) and covers any and all programs that your child participates in during that time. If any information changes throughout the year, please update it when registering for programs.

  • The following people have permission to pick up my child:

  • PERMISSION FORM

    Permissions below cover any and all programs that your child participates throughout the year. Please inform staff if there are changes related to a specific program.

  • MEDICAL INFORMATION

  • If medication needs to be administered during a program, please complete the Medication Administration Form

  • EMERGENCY CONTACT INFORMATION

    Two contacts other than parents/guardians

  • Form Submission

    By submitting this form electronically, you agree that you have read, understood and provided accurate information.
Save and Continue Later

Click here for the Medication Authorization Form