CPE Youth Registration Form

ABOUT YOUR TEEN

First Name *

Last Name *

Date of Birth *

Gender *

Home Church *

Home Church - Other (Please Specify)

School *

School Year *

Medical Allergies/Dietary Requirements *

We are a NUT FREE Zone - please do not bring anything containing any Nuts to Church due to allergy risk.

Physical, psychological or behavioural conditions

Medications

YOUR TEEN'S CONTACT DETAILS

Mobile Number *

Email Address *

Home Address *

I agree/disagree to CPE Youth Leaders contacting my Child for the purpose of providing information about CPE Youth activities and adding them to the CPE Youth Teens WhatsApp Group Chat. *

Preferred Method of Contact (i.e. WhatsApp, text, email, other) *

EMERGENCY CONTACT DETAILS

Parent/Carer 1 Details

Parent/Carer Home Church *

Parent/Carer Church - Other (Please Specify)

Parent/Carer (Primary) relationship status *

Parent/Carer First Name *

Parent/Carer Last Name *

Parent/Carer Mobile Number *

Parent/Carer Email Address *

Parent/Carer Preferred Method of Contact (i.e. WhatsApp, text, email, other)

...

Parent/Carer 2 Details

Parent/Carer (Secondary) Relationship Status

Secondary Parent's First Name

Secondary Parent's Last Name

Secondary Parent's Mobile Number

Secondary Parent's Email Address

Photography and Video Permission

I understand that there will be times when leaders may take photographs and/or video clips during youth group activities to keep a record of the event. I understand that these photographs and/or video clips may be used on websites, Facebook, church publications, promotional materials or other communication platforms for the purpose of raising awareness of CPE Youth to the wider community.

I agree/disagree for the use of my child's photograph/video as per above. *

All information is collected & protected per our privacy policy.

Declaration

By clicking SUBMIT, you acknowledge the information that you have supplied is accurate and that you are the legal parent/guardian for the teen being registered.

Additional Comments