TE HUA O TE MAMAKU YOUTH GROUP Registration Form
Youth Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
IG handle / Phone number to contact you
*
This will be the main contact
Email Address
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What school do you go to?
What year level are you at school?
What inspires you to join TE HUA O TE MAMAKU youth group?
*
Tell us why
Medical / Learning conditions we should know about
*
Do you have any allergies?
Do you have any medical conditions that we should be aware of?
Parent/Guardian Information
Full name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Relationship
*
Acknowledgment
I agree to follow the guidelines, rules, and policies of the organization. If a chaperone or driver is needed, I'll do that. I allow my child to be photographed or be part of the video that will be used for marketing, promotion, and advertisements. The repeated offense of the youth may result in suspension or expulsion. Parent/Guardian registered in this form has legal custody over the child. I allow my child to ride any vehicle that is related to the group's activities provided that there's an adult on board. For medical emergencies, I allow the medical team of this organization to take care of my child. I release this organization from any and all liability from accident or injury to the child during the organization related events.
Parent/Guardian Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: