Summer youth program registration form

Student Name (required)

Below are some questions to help staff members better serve your student. Information provided will be used to help us plan and organize classes.

Is your student able to ride the UTA alone?
Needs Help?
Able to Transfer Busses?
Needs Training?
Do you want training?

Is your student able to recognize dollar amounts?

How long can your student go between bathroom breaks?

If your student needs a personal assistant, can you provide one?

Does your student have special dietary needs?

Other comments, concerns or accommodations your student will need to participate?

Ability 1st Utah 2016 Youth Summer Program Agreement Form

I hereby give permission/agree for the above listed student to participate in Ability 1st Utah’s Youth Summer Program. With this fully signed permission form, I hereby release and discharge Ability 1st Utah and its employees from all liability, claims, and/or demands for property damage and personal injury which may arise from an accident or injury while attending activities in the summer program or in being transported to and from these activities.

I agree to authorize Ability 1st Utah to take and utilize photographs, videos, and/or other audio-visual materials for its use. These materials will be used for public awareness, public relations, and fundraising. I also understand that I will not be compensated monetarily or otherwise for use by Ability 1st Utah.

Consumer of legal age & status signature:

Type name: Date:

Parent/guardian signature:

Type name: Date:

In case of an emergency I can be contacted at the following number:

Secondary emergency contact and number: