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Crosslife Youth Enrolment Form 2023
At Shellharbour City Anglican Church we seek to uphold our duty of care for you and your family as you participate in the programs we run. The questions in this form are intended to provide all the appropriate information necessary to ensure that we achieve this aim.
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* Indicates required question
Youth Surname
*
Your answer
Youth First name
*
Your answer
Parent/Guardian 1 Surname
*
Your answer
Parent/Guardian 1 First name
*
Your answer
Parent/Guardian 1 contact phone number (please put a space after the 4th and 7th numerals - eg, 0412 345 678)
*
Your answer
Parent/Guardian 1 email address.
*
Your answer
Parent/Guardian 2 Surname
*
Your answer
Parent/Guardian 2 First name
*
Your answer
Parent/Guardian 2 contact phone number (please put a space after the 4th and 7th numerals - eg, 0412 345 678)
*
Your answer
Parent/Guardian 2 email address
*
Your answer
Gender
Male
Female
Clear selection
School
Your answer
Year at school (or equivalent)
Choose
7
8
9
10
11
12
Date of Birth
*
MM
/
DD
/
YYYY
Youth's address
*
Include suburb & post code
Your answer
Youth's email address
(if applicable)
Your answer
Youth's mobile phone number (please put a space after the 4th and 7th numerals - eg, 0412 345 678)
(if applicable) (please put a space after the 4th and 7th numerals - eg, 0412 345 678)
Your answer
Secondary emergency contact (who is not a parent/guardian)
*
If parent cannot be reached in the case of an emergency. Please include name, relationship to child and phone contact.
Your answer
Secondary emergency contact number
*
Your answer
Does your child have any allergies, dietary requirements or health needs we should know about?
Your answer
I authorise the Crosslife 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.
*
Yes
No
Medicare number
*
(in case of an emergency where medical care is needed)
Your answer
Reference Number (next to young person's name on card)
*
Your answer
Medicare Card Expiry (--/----)
*
Your answer
Does your family go to church?
Yes, we attend church here at Shellharbour City Anglican
Yes, we belong to another local church
We do not usually attend church
Clear selection
Are you happy for us to communicate about Crosslife Youth to you and your child via SMS, email or social media in exceptional circumstances (eg COVID-19)?
*
This usually only happens if details change or in the lead up to special activities.
Yes
No
Do you give permission for your child to be photographed or filmed in the context of their participation in Crosslife Youth?
*
Yes
No
Do you give permission for photos of your child to be used on church social media platforms and/or church website?
*
Yes
No
Who can drop off/collect your child from Crosslife Youth?
*
Please include the names of any drivers who may drive your child at any time.
Your answer
Is there anyone who is legally restricted from seeing your child?
*
If Yes, please provide the name of the person and a copy of documentation to the Ministry Leader.
Your answer
Is there any other information that you think we should know in relation to your child's enrolment at CrossLife Youth?
Your answer
Submit
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