Blacktown Anglican Youth Registration Form • Blacktown Anglican Church

Family Address

Youths' Details

Address *

Suburb *

Postcode *

Home Phone Number

Parent/Carer Mobile Number *

Parent/Carer Email Address

Emergency Contact Name *

Emergency Contact Number *

Permission for Photos

First Name *

Preferred Name

Last Name *

Youth's Mobile Number

Date of Birth *

School Grade *

School *

Gender *

Allergies

Special Needs *

Further Information

Please read this statement carefully:

I give consent for my youth to participate in all organised activities, to be photographed or videoed as needed for church promotional purposes, to receive medical aid in the event of any accident or sickness and agree to pay any fees thus incurred. I understand that personal accident insurance is my responsibility, and that Blacktown Anglican Church and its representatives accept no liability for any accidents. I understand that my youths' basic information may be accessed by those in the church community with up-to-date working with children and safe ministry accreditation.

Please speak to the Kids, Youth and Families Minister - Renee Gosbee, or the Senior Minister - Luke Thomson, if you have any concerns. (Renee: 0434043581 // renee@bac.org.au; Luke: 0402429213 // luke@bac.org.au)

I accept and give consent *

Yes

Date *

Signature *

Tip: Please type your full name to sign this form