AIC Youth Club Membership
Register your child as an AIC Youth Member to access member benefits, selected event discounts, competitions, rewards and our youth points program. Each registered member will receive their own AIC Youth Membership Card.
Child Details
Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Gender
*
Please Select
Male
Female
Photo for ID Card (if you want it printed on the card)
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Parents / Guardian details (Main contact)
Parent/Guardian 1
*
First Name
Last Name
Relationship to child
*
Mobile Number
*
Email
*
Parents / Guardian details (Secondary Contact)
Parent/Guardian 2
First Name
Last Name
Relationship to child
Mobile Number
Email
Child Information
Does your child have any medical conditions, allergies, additional needs or other information we should be aware of?
*
Yes
No
If Yes, please list provide further details
Address
Street Address
Street Address Line 2
Suburb
State
Postcode
Photography & Media Consent
I give permission for photographs or videos of my child taken during AIC programs and events to be used by the Australian Islamic Centre for community communications, website and social media
*
Yes
No
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