Crossgar JYC – Young Person Registration Form

Young Person's (YP) name: *

First

Last

Date of birth: *

Address: *

Multiple Choice

Parent/Guardian's name: *

First

Last

Email *

Email

Confirm Email

Phone: *

Receiving announcements:

Who should receive Crossgar JYC announcements? (or tick both)

Email of YP receiving announcements:

Email of parent receiving announcements:

Medical information:

Are there any medical conditions (i.e. allergies, epilepsy, asthma, diabetes, travel sickness, ADHD, etc.) which we should be aware of?.

Please give any details of special dietary needs we should be aware of (e.g. food allergies)

Photography: *

Do you consent to photos being taken and shared for advertorial purposes (church newsletter/facebook page)?

Any other comments?