RHJYC Membership Registration Form

Rose Hill Junior Youth club Membership Registration

Complete the form below to sign up for our youth clubs
Child 1 name: *

First Name Last Name
Child 2 name:

First Name Last Name
Child 3 name:

First Name Last Name
Parent/carer name: *

First Name Last Name
Phone Number: *

Area Code Phone Number
Address: *

Street Address

Street Address Line 2

City

Postal / Zip Code Country
Birth Date (Child 1): *

Month Day Year
Birth Date (Child 2):

Month Day Year
Birth Date (Child 3):

Month Day Year
Where did you hear about us?

A friend Social media School Local news
School Name (in order of child): *
School Year(s) (specify which year both children are in): *
Medical information:
Please list any relevant medical information, including any dietary requirements & allergies (list separately for each child): *
Can we administer pre-approved medication & medical aid to your child(ren)? *

Yes No
Photo consent:
As a registered charity, we are required to evidence our activities by taking photographs and videos for funders, our social media sites and occasional press articles. Please check the box below if you give us photo consent:
Photo/video consent options *

Full face/body is ok No identifying features (face) Just hands/back of body (non-identifying) None at all
Who will pick the child up:
Who will pick the child(ren) up? *
Parent/carer submit:
I have read, understood, and filled in the membership form.
Once you submit your application, we will contact you shortly to complete your membership application. Thank you!
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Rose Hill Junior Youth club Membership Registration

Medical information:

Photo consent:

Who will pick the child up:

Parent/carer submit: