Lytehouse Youth - New Student Information

Your name *

Email address *

Phone number *

Birthdate *

Grade *

School *

Who Invited You? *

Allergies/Special Needs/Dietary *

PARENT/GUARDIAN INFORMATION

Parent/Guardian(s) Name(s) *

Parent/Guardian Email *

Parent/Guardian Phone *

Address *

Favourite Candy *

Favourite Chocolate *

Favourite Fast Food *

Media Permissions *

As Parent/Guardian of the student mentioned above, I provide LYM permission to:
(Check all that apply)

follow my teen on their existing social media accounts (i.e.: Instagram, Snapchat, etc)

send text notifications to my teen of upcoming events/cancellations

include my teens photo on social media promotions/updates from LYM’s accounts

add my email to the mailing list for LYM info

add my mobile number for text notifications related to LYM events/info

none of the above