Fuse - South Coast Life Church

Fuse Road Trip Permission

On Friday 2nd June Berry Youth is driving to Fuse Youth Gathering at Kingsway Community Church. We will leave South Coast Life Church, Berry at 5pm and return around 11pm. Cost is $5 entry + $ for food. This form is to be completed by the parent or guardian of the teenager attending the Fuse road trip. (Please fill out one per young person.)

Youth Information

* Indicates required field

First Name *

Surname *

Grade *

Date Of Birth *

Youth Mobile *

Parent /Guardian Information

Parent 1 Name *

Phone number *

Parent 2 Name *

Phone number *

Medical Information

Emergency Contact *

Medicare Number *

Phone Number *

Allergies/Medications *

I give permission for

Name Of Youth *

to drive to and from Fuse Youth Gathering at Kingsway Community Church, Caringbah with Berry Youth.

Name (Parent/Guardian) *

Date *

Submit