V61 Youth
Hello Parents and Carers,

We would like to ensure the safety of the young people that are in our care. Please fill out all the information below so that we can better serve our youth.

This is a safeguarding requirement for every child and young person that is under our care. If you have any questions you may email me at youth@vineyard61.org
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Email *
Child's name *
Sex *
Date of birth *
MM
/
DD
/
YYYY
What School does your child attend? This information helps us create a calendar in mind for term breaks. It's not mandatory, but appreciated for our planning of youth groups and events.
What church do you attend? *
Child email and Mobile number
Email and Phone number
What is the best way to contact your youth directly?
(For last minute updates, rotas, youth group/discipleship information)

Please select ALL that apply
 *
Required
Parent/ guardian name *
Parent/guardian email and phone number *
Permissions for contact with Parent/guardians *
Required
Photo/video consent *
Required
Medical needs or concerns
Two Emergency Contacts *
Submit
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