Youth Program Registration We've made some changes to our registration form in hopes of making the experience better for you. If you need any support registering or have questions, call Aaron at 866-442-3529 or email aaron@on-belay.org. Registration for Mini Adventures:Please select the age group that corresponds to your child's age. If registering more than one child, select all the age groups that apply. 8-10 years old, Saturday, March 16, 2019 11-13 year old, Sunday, March 17, 2019 Registration for Mini AdventuresHave you registered your child(ren) for an On Belay program before?*YesNoYour Name* First Last Please update any of the following: Phone Number Mailing Address How is cancer affecting your child(ren) Who in your family is affected by cancer Email*Please provide an email address at which we can send program information and updates Enter Email Confirm Email Phone*Please provide a phone number at which we can call to share program information and updatesMailing Address* Street Address City State / Province / Region ZIP / Postal Code Child's Name #1* First Last Date of Birth* MM DD YYYY Age*On Belay programs are open to youth ages 8-18How are you related to child #1?*ParentGrandparentStep-parentWould like to register another child?YesNoChild's Name #2* First Last Date of Birth* MM DD YYYY Age*On Belay programs are open to youth ages 8-18How are you related to child #2?*ParentGrandparentStep-parentWould like to register another child?YesNoChild's Name #3* First Last Date of Birth* MM DD YYYY Age*On Belay programs are open to youth ages 8-18How are you related to child #3?*ParentGrandparentStep-parentWould like to register another child?YesNoChild's Name #4* First Last Date of Birth* MM DD YYYY Age*On Belay programs are open to youth ages 8-18How are you related to child #4?*ParentGrandparentStep-parentHow has cancer affected your child(ren)*Family member in treatmentFamily member in remissionLost a family memberWho in your family is affected by cancer?*As related to the child(ren) you are registeringMotherFatherSisterBrotherWhat type of cancer is effecting your family?*What hospital or cancer center is providing or was providing treatment?*How did you hear about On Belay programs?*
