ICONZ Registration Form 2024

ICONZ Registration Form 2024 - Term 1

ICONZ Cambridge, Raleigh Street Christian Centre
I would like to enrol my boy/s as a member of the ICONZ programme of The Boys' Brigade in New Zealand.
Usual meetings during School terms: Monday nights 6:45pm - 8:30pm at the RSCC Church Hall.
Parent / Caregiver details

(enter your boys details in the next section)
Name of Parent / Caregiver*

First NameLast Name
Contact Email of Parent / Caregiver*
example@example.com
Alternative Email for contact
example@example.com
Mobile phone number/s*
Home phone number (if any)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Church Attended (if any)

Boy #1

(if you have more than 1 boy, enter his details in the next section)
Boy's full name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Current age (boys must be aged between 8 and 12 years old)*

89101112
School Year*
Any Health Information
Do you have another boy to register?*

NoYes

Boy #2
Boy's full name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Current age (boys must be aged between 8 and 12 years old)*

89101112
School Year*
Any Health Information

Acknowledgement and Form Submission

Please read and indicate your acceptance of the associated conditions and permissions. Please feel free to discuss anything if you have concerns.

The ICONZ leaders look forward to getting to know you boy/s this year!

Thanks for your support.
I/we give permission for our child to take part in activities within our local community (for instance near RSCC or at a local park). Any activities further afield will be notified and require a permission form.*

Yes, I do
I understand that while the ICONZ Leaders will take all reasonable responsibility to ensure the safety of my boy/s, they cannot be held liable for consequences resulting from any accidental injury while he is in their care.*

Yes, I do
I agree that my boy must abide by the rules and reasonable instructions of ICONZ Leaders, and that I may be required to collect him if requested by the Leaders.*

Yes, I do
From time to time, photos of activities that the boys are involved in may be placed on the RSCC / ICONZ website or newsletter as part of our promotion. Names of boys will not be published unless specific permission is obtained. I give permission for photos of my child to be included.

Yes, I doMaybe - check first for all casesUnder no circumstances
I agree that this information will be kept on record by RSCC and the ICONZ Unit for administrative purposes and that I can correct and/or remove this information if required at any time.

Yes, I do
Contact: Glenn Johnson. Tel: 021 255 8423 Email: cambridgeiconz@gmail.com
Should be Empty:

ICONZ Registration Form 2024 - Term 1