Saint Paul's Boronia Youth Registration Form 2023

Saint Paul's Anglican Church Boronia Youth Registration Form 2023
This form is to be filled out by the parent/guardian of the participant/s and is intended for communication purposes and to assist leaders in case of any medical emergency. This information will not be shared with outside parties without your permission unless required by law.
Youth's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Year Level in 2023*
Are You Registering More Than 1 Youth?

YesNo
Youth's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Year Level in 2023*
Are You Registering More Than 2 Youth?

YesNo
Youth's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Year Level in 2023*
Are You Registering More Than 3 Youth?

YesNo
Youth's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Year Level in 2023*
Email Address*
To be informed of the latest updates from SPY
Additional Email Address
If anyone else would like to receive updates from SPY
Additional Email Address
Additional Email Address
Parent/Guardian's Name*

First NameLast Name
Phone Number*
Additional Parent/Guardian's Name

First NameLast Name
Phone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact's Name (Other Than Parent/Guardian)*

First NameLast Name
Emergency Contact's Relationship to Participant/s*
Emergency Contact's Phone Number*
Additional Adults Authorised to Pick up my Child From SPY

First NameLast Name
First NameLast Name
First NameLast Name
First NameLast Name

Medical Conditions

Will Your Youth Have any Medication at SPY?*

YesNo
Please Provide any Details of Medical Conditions (Including Details of Medication)
If you have any action and/or asthma plans, or any other relevant documents to provide, please attach them below or bring them on your first session at SPY.

Please discuss any special concerns with a leader.
Browse Files

Cancelof
Does Your Youth Have any Dietry Requirements?
Please Provide Details.
Is Your Youth's Immunisation up to Date?*

YesNo

By participating in this program I authorise the leaders in charge of any activity conducted by Saint Paul’s Anglican Church Boronia to consent on my behalf, where it is impractical to communicate with me, for my child to receive medical or surgical treatment as may be deemed necessary. I am also responsible for the cost of any medical treatment deemed necessary.

I give permission for my child to be transported to events and external activities in private cars arranged by the leaders (Note: L’s & Red P’s will not be driving the youth).
Do you authorise for your child/ren to be included in photos and/or videos that may be used to promote Saint Paul’s ministries in a way that does not identify their full name (without their permission i.e. tagged on SPY facebook page) or personal details?*

YesNo
Do you authorise for your child/ren to watch M/MA rated content for teaching purposes where deemed appropriate by the leaders? This will not include sexual content, nudity and abusive or obscene language.*

YesNo
Signature

Clear
Parent/Guardian Authorising Name:*

First NameLast Name
Date

DayMonthYear
Should be Empty:

Saint Paul's Anglican Church Boronia Youth Registration Form 2023