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KSBC Peak Youth Registration Form
We are excited that your teenager is able to participate in the KSBC Youth program. In order for us to provide the best level of care while your teenager is under our supervision, we require that you fill out the registration form below for each teenager. The information provided below will be treated confidentially.
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* Indicates required question
Email
*
Your email
Parent/Guardian Name
*
First and Surname
Your answer
Parent/Guardian Contact Number
*
Your answer
Teenager's Name
*
First and Surname
Your answer
Address
*
Your answer
Teenager's Date of Birth
*
MM
/
DD
/
YYYY
Teenager's Gender
*
Male
Female
Prefer not to say
Teenager's Year Level
*
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Is there any medical information that we should know?
Including medical conditions, allergies, dietary requirements etc.
Your answer
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