YMCA Taranaki Youth Community Army Registration Form

YMCA Taranaki Youth Community Army Registration Form
Please provide all details to ensure we aware of any health concerns and can contact someone in case of an emergency. Your confidentiality is important to us and it will not be used for any other purposes unless permission is provided. One form per youth will be required. Thank you!
Name*

First NameLast Name
Age*
E-mail*
Cell Phone*

0210000000
Gender*

FemaleMaleGender DiverseOther
Ethnicity*

NZ European/EuropeanMaoriPasifikaAsianOther
Names of iwi/tribes if applicable

Your photograph, audio and video recordings may be taken for use in printed publications, online marketing and any other promotional materials for the YMCA. You will not be identified by full name.
I agree to the use of photos, videos, and audio of me*

YesNo
Which volunteer events are you interested in?
After the workshop/activity is finished, I/the youth*

Will walk/bike homeWill be picked upRequires transportOther
Address

Street Address

Street Address Line 2

CityState / Province
Please join the Youth Community Army Facebook Page or the Instagram profile YHubTaranaki to be notified about events.
If you wish to be directly contacted with updates please provide permission here:
Do you give permission to be contacted about future Youth Army events?*

YesNo
I confirm that all the information I have provided is true and correct to the best of my knowledge.

I am aware and satisfied that I am fully aware of the content of this programme.

I acknowledge that every precaution will be taken to prevent accidents or unforeseen events from occurring while I attend events as part of the Youth Community Army. I accept there may the possibility of injury or accidents but I accept the responsibility and the YMCA Taranaki, Staff, Volunteers, or other helpers will not be held liable for any injury, damage to property, or loss of property.
Any further comments or questions
Youth's signature (use mouse pointer to draw)*

Clear
Parent/guardian signature*

Clear
Today's Date

DayMonthYear
Date
Should be Empty: