YOCP-200 Student Intake

Please complete this form to the best of your ability. Your information will be kept confidential and is used to ensure both your safety and the safety of the instructors. It will not be disclosed to anyone outside of the teaching faculty with out your written consent, will be kept secure, and will be destroyed after 3 years.
  • We will contact this person in the event of an emergency and/or if we have concerns about your well-being.
  • Please provide the best number to reach them at in case of an emergency.
  • Please let us know who they are.
  • If yes, what are they?
  • If yes, what are they?