YouthLIFE 2023

Details About Youth

First Name *

Last Name *

Preferred Name

Gender

Mobile Number

Email Address

Mailing Address

Mailing Postcode

Date of Birth

School

School Year

Medical Behavioural Details

Allergies

Anaphylaxis

Yes (food related)

Yes (non food related)

Anaphylaxis Details

Helpful Information

Parent/Guardian Details

Parent 1 First Name *

Parent 1 Last Name *

Parent 1 Phone *

Parent 1 Email *

Add second parent's details

Yes

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Phone

Comments

From time to time leaders from YouthLIFE may contact your child for encouragement (years 10-12) and logistics (years 7-12).

YouthLIFE Contact Permission *

Do NOT contact

YouthLIFE leaders may contact my child

From time to time photos and videos of youth taken at YouthLIFE events will be displayed publicly (online and in print) unless indicated below.

YouthLIFE Photo Consent *

I DO NOT want photographs taken of my child

Photographs may be taken of my child

By submitting this form, I give permission for my child to attend regular activities at YouthLIFE.

I authorise the YouthLIFE leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue or other services that are considered necessary for my child.

Signed by: *

Registration Form Only 0

Details About Youth

Parent/Guardian Details