2023 Alexandria YIP Registration YOUTH INFORMATIONName of Youth Participant(Required) Nickname of Youth Participant Gender Male Female Email(Required) Address(Required) Street Address City ZIP Code State(Required)Please select your stateAlabama (AL)Alaska (AK)Arizona (AZ)Arkansas (AR)California (CA)Colorado (CO)Connecticut (CT)Delaware (DE)District of Columbia (DC)Florida (FL)Georgia (GA)Hawaii (HI)Idaho (ID)Illinois (IL)Indiana (IN)Iowa (IA)Kansas (KS)Kentucky (KY)Louisiana (LA)Maine (ME)Maryland (MD)Massachusetts (MA)Michigan (MI)Minnesota (MN)Mississippi (MS)Missouri (MO)Montana (MT)Nebraska (NE)Nevada (NV)New Hampshire (NH)New Jersey (NJ)New Mexico (NM)New York (NY)North Carolina (NC)North Dakota (ND)Ohio (OH)Oklahoma (OK)Oregon (OR)Pennsylvania (PA)Puerto Rico (PR)Rhode Island (RI)South Carolina (SC)South Dakota (SD)Tennessee (TN)Texas (TX)Utah (UT)Vermont (VT)Virginia (VA)Virgin Islands (VI)Washington (WA)West Virginia (WV)Wisconsin (WI)Wyoming (WY)Armed Forces AmericasArmed Forces EuropeArmed Forces PacificDate of Birth - must be mm/dd/yyyy format(Required) MM slash DD slash YYYY Grade as of Fall 2023 (6th, 7th, 8th Grade)(Required) School(Required) School District(Required) Height Weight (in lbs)Does your child have any medical/physical conditions?(Required)SelectYesNoIs your child currently on medication?(Required)SelectYesNoDoes your child have any allergies?(Required)SelectYesNoPlease list all medical conditions, allergies and medications(Required) If none, put noneT-Shirt SizeSelectYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLShorts SizeSelectYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLParent Guardian InformationName of Parent or Guardian(Required) Relationship to student(Required) Cell Phone Number(Required)Email(Required) Emergency Contact informationName(Required) Relationship to Student(Required) Cell Phone Number(Required)Statement of Responsibility:I, the Legal Guardian, understand that in completing this application, I support my child in participating in this academic and athletic program(Required)SelectYesNoI will not schedule vacation time or admit my child into other camps during the program dates, otherwise I forfeit their spot as to allow another camper to attend(Required)SelectYesNoI assume FULL risk and responsibility for their commitment and participation in this program and I agree to waive any claims against the YIP and the Host Organization(Required)SelectYesNoEntering Parent/Guardian name here authorizes legal representation for youth participation(Required) Hiddensource