Youth Registration

This form is to be completed by the parent or guardian of the teenager attending Berry Youth. (Please fill out one per young person.)

Youth Information

* Indicates required field

First Name *

Surname *

Grade *

Date Of Birth *

Gender *

Male Female

School *

Address *

Suburb *

Postcode *

Youth Mobile *

Parent 1 Name *

Phone number *

Email *

Parent 2 Name *

Email *

Phone number *

Emergency Contact *

Phone Number *

Medical Insurance Company *

Policy Number *

Medicare Number *

Allergies/Medications *

Member name *

Please indicate Y/N

I agree to photographs and videos of activities including my youth to be taken for use within the church community. *

Yes No

I agree to photographs or videos including my youth to be used on social media. *

Yes No

I agree to Berry Youth Leaders administering paracetamol if required. *

Yes No

I give permission for

Name Of Youth *

to attend the Youth Ministry at South Coast Life Church. This includes activities, events, outings and other functions.

Name (Parent/Guardian) *

Date *

Submit