Youth Ministry Registration (Youth) • St Luke's Liverpool

Thank you for registering your child!
Please fill in the form below so that we will have all the details we need to take good care of your child.
This form is to be filled out only by the youth's parent/guardian.

Youth Details

First Name *

Preferred Name

Middle Name

Last Name *

Sex *

Date of Birth *

School *

School Grade *

Media Permissions *

Yes

Tip: I give permission for photos/videos of my child to be taken that may be used to advertise the group.

Special Needs *

Yes

Allergies / Medical Conditions *

Tip: If none, write 'none'

Prohibited Persons *

Tip: Is there anyone who is legally restricted from seeing your child? If none, write 'none'

Contact Details

Youth Email Address

Youth Phone Number

Youth Mobile Number

Home Address

Home Address *

Home Address Line 2

Home Suburb *

Home State *

Home Postcode *

Home Country *

Comments

Tip: Do you have any questions, concerns or additional comments for us?

Click 'Register Another Youth' to register another child.
Click 'Submit' to go onto the next page to provide us with your parent/guardian details.