2024 Youth Short Enrolment Form • Christ Church

This enrolment form is essential for all youth who attend Regen Youth at Christ Church Gladesville.

Youth details

First Name *

Last Name *

Date of Birth *

Youth Email Address

Mailing Address

Mailing City

Mailing Postcode

Gender *

School Grade *

School Name (if the school is not listed, select OTHER and type the school's name in the box below) *

If the school is not listed, please type it here

Does your child have any allergies? If YES, please provide details of allergies in the next box. Please email office@christchurch.org.au with response plans for anaphylaxis or asthma if applicable. *

No known allergies

Yes (has allergies)

Is there anything that would be helpful for us to know in caring for your child (allergies, impairments, behavioural issues, prescription medication, chronic illness, special diets etc).

Parent/Guardian Information

Parent/Guardian #1.

This is the main contact for all parent notices and communication regarding Regenerate.

Parent/Guardian #1: Full Name *

Parent/Guardian #1: Email *

Parent/Guardian #1: Phone Number *

Parent/Guardian 2: Full Name *

Parent/Guardian 2: Phone Number *

Alternative Emergency Contact

Details of a third adult to contact in the event we cannot get in touch with Parent/Guardian #1 and #2 in an emergency

Alternate Emergency Contact: Full Name *

Alternate Emergency Contact: Phone Number *

Photo Permission

Do you give permission for photos and videos taken of your child at an activity of Christ Church Gladesville (including children's and youth programs), to be published by Christ Church Gladesville in print and online?

Photo/ video permission given *

Yes

Do you give permission for photos and videos taken of your child at an activity of Christ Church Gladesville to be used for internal purposes only (including but not limited to, in our church services [not including livestream], in our children's programs, and in our emails / newsletters)?

Photo / video permission given for internal use only *

Yes

Date