UJC-OG 2026 Registration Form

Full name

Your full name as it appears on official documents.

This field is required.

Age

Your age at the time of registration.

This field is required.

Gender

Select your gender.

Female

Male

Other

This field is required.

Address

Your full address.

This field is required.

City

Your city of residence.

This field is required.

Phone

Your phone number.

This field is required.

Email

Your email address.

This field is required.

Parent / guardian name

Full name du parent ou tuteur.

This field is required.

Parent / guardian phone

Parent or guardian's phone number.

This field is required.

Parent / guardian email

Address e-mail du parent ou tuteur.

This field is required.

Programs

Select the programs you want.

Homework club

Tutoring

Soccer

Basketball

Mental health

Employment program, ages 18-29

This field is required.

Allergies

List all known allergies.

Medical conditions

Describe any relevant medical condition.

Medications

List all medications currently taken.

Emergency contact

Name and phone number of the person to contact in an emergency.

This field is required.

Participation consent

I consent to taking part in the program.

This field is required.

Photo consent

I consent to photos being taken and used as part of the program.

This field is required.

Confirmation of information

I confirm that all the information provided is correct.

This field is required.

Email

This field is required.

Textarea

Checkbox

Number