Want to join us for one of our dynamic and engaging summer programs, here’s the place to do it. Complete the form below and submit it and we will confirm your spot has been saved for your youth. Along with this please download and complete all the forms attached here and submit to seedrooted@gmail.com

Medical Waiver Form

Code of Conduct Form

Passenger Liability Form

Payment can be made by email transfer to seedsrooted@gmail.com, PayPal transfer to seedsrooted@gmail.com or mailed to Janneke Vorsteveld, P.O. Box 2010, Bayfield ON, N0M1G0. Please make the payment of $250/youth at time of registration.

Youth Information
Youth's Name *
Youth's Name
Address *
Address
Youth Date of Birth *
Youth Date of Birth
Parent/Guardian Information
Parent/Legal Guardian Name *
Parent/Legal Guardian Name
Phone *
Phone
Parent/Legal Guardian Name 2 *
Parent/Legal Guardian Name 2
Phone *
Phone
Emergency Contact Information
Emergency Contact Information (if parent/guardian is not available) *
Emergency Contact Information (if parent/guardian is not available)
Emergency Number *
Emergency Number
Email Confirmation
Youth Photo Release
I agree that photos of my youth can be taken and used for Social Media purposes for Seeds Rooted in Youth *
Program Selection
Summer Program Selection *
T-shirt Only for Full Week
What size of t-shirt?