Parent's DetailsParent's / Caregiver's Names *Parent's / Caregiver's Names Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryEmail *Phone *Alternative Emergency Contact DetailsName Phone Relationship to young person Young People's DetailsYoung Person's Name Year Level Year 7Year 8Year 9Year 10Year 11Year 12Year 13Young Person's Name Year Level Year 7Year 8Year 9Year 10Year 11Year 12Year 13Young Person's Name Year Level Year 7Year 8Year 9Year 10Year 11Year 12Year 13Food Allergies or Dietary Requirements Please let us know if there are any requirements we need to know about Authorisation By typing my name below, I agree to the following. I agree to be contactable during youth group in case of an emergency. We will provide to the youth co-ordinator written/verbal and confidential advice of any significant physical, mental, emotional, or development issues affecting my child (this allows us to pastorally care for them). If my child is involved in a serious disciplinary problem, including the use of illegal substances and/or alcohol, or actions that threaten the safety of others, he/she will need to be collected at my own expense as Parent/Caregiver.Name * There will be times in which we will take photographs of our youth groups and any youth events. These images may include your children. We will make sure that only first names are used (if we use names). These images will be used for the promotion and reporting of our youth ministry within the Parish or Christchurch Diocese. Please let us know if it is ok to use images that may have your children in them.Permission for use of children's images *I give permission for images to be usedI don't give permission for images to be used Contribution We invite those who are able, to bring a gold coin donation when they arrive at youth group. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
