Youth Registration Form • Mayfield Baptist Church

Mayfield Youth Registration Form

Child/ Young Person's First Name *

Child/ Young Person's Last Name *

Date of Birth *

Gender

School Grade *

Child/ Young person's Mobile

Tip: Permission to contact below

Child/ Young Person's Email

Tip: Permission to contact below

Parent/Carer's Name *

Parent/Carer Phone Number *

Parent/Carer Email Address *

Address

City

State

Postcode

Medical Information

Are there any allergies, dietary requirements, physical needs or medical issues we should be aware of? *

Tip: If yes, please provide further details/action plan.

If you have an action plan for management of anaphylaxis, asthma or any other condition please provide a copy via email to mbc@mayfieldbaptist.com so that leaders can be made aware of it.

Food Intolerances

Allergies

Medical issues/physical needs to be aware of

Emergency Contact Information

Alternative contact details in case we are not able to contact you in an emergency (Please inform this person that you have submitted their details)

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship to the child/ young person

Thank you for providing this important information. We will store your details in accordance with the Recordkeeping section of our Safe Church Policy which can be found on our website along with our other Policies and Procedures: https://www.mayfieldbaptist.com/safe-church

Mayfield Youth Registration Form

Medical Information

Emergency Contact Information

Permissions Given