Name (Required)

Email Address (Required)

Youth/Youths full name/s (Required)

Date(s) of Birth (Required)

Does your child/ren have any known allergies, asthma or other health issues? (Required)

Do you grant permission for us to email you about kids or youth events and activities? (Required)

Do you give permission for the church administrator or youth leader to contact your youth directly regarding activities and other Youth Group related information? (Required)

Are there any persons not permitted to contact or collect your youth? (Required)

Please provide Emergency Contact details (name and mobile number) of someone other than yourself in case of Emergency (Required)

Please provide medicare number (Required)