If you are between 12-18 years old, we would love to meet you!

Please fill out the membership application and bring it with you to the Centre.

Youth Information

Please fill in all applicable spaces to the best of your ability. You must be between the ages of 12-18 years old to attend LCYC!
Youth Name(Required)
Birth Date(Required)
Are you First Nations/Metis/Inuit?

Parent/Guardian Information

Youth Lives With(Required)
Parent/Guardian Name(Required)
Address (if different than youth's)
2nd Guardian Full Name (if applicable)
Address (if different than Youth's)

Emergency Contact Information (other than parent/guardian)

Emergency Contact Full Name

Program Consent

I, the parent/guardian of the above mentioned youth acknowledge the risks associated with my child participating in any events, programs, and activities scheduled with the Lloydminster Community Youth Centre (LCYC), a division of the Lloydminster Interval Home Society (LIHS). LIHS is legally responsible to contact Child & Family Services if there are concerns for your child's safety or well-being. This includes information that is disclosed to staff by youth.
Please check off to indicate consent on the following:
I give permission to LCYC/LIHS staff to transport youth within the 50-km service area of Lloydminster. This includes rides home, rides to off-site trips & programs, and pickups from the schools.
I give consent for my child to be in pictures and/or audio-visual productions for promotion, advertising or fundraising activities unless otherwise stated. This includes LCYC and LIHS social media.
I agree that the Lloydminster Interval Home Society is not responsible for illness or injury of my child or any loss to my child's property.
I understand my child will have access to various mental health supports & life skills development, including educational sessions and support provided by third parties such as Saskatchewan Health Authority, Alberta Health Services, etc.