Youth Registration Form

Youth Registration Form

Fill out the form carefully for registration
Young persons Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-Mail*
example@example.com
Young persons Number
Parent/Caregiver Name*

First NameLast Name
Parents Email*
example@example.com
Parents Number*
Medical Conditions
Other Authorised Carer
Allergies
Other Important Information
Do you give permission for your young person to be photographed or filmed for promotional purpose to be displayed on social media or the church website?*

YesNo
Do you give permission for your young person to be contacted by our youth pastor or a youth leader?*

YesNo
Acknowledgment*

Parents will be CC'd in all communication from youth leaders to their child/children
Signature*

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