CCW Youth Registration 2025

Youth Information

First Name *

Last Name *

Preferred Name/s

Date of Birth *

School Year *

Mobile Number

Email Address

Home Address

City/Town

State

Postcode

Parent/Guardian Information

Parent/Guardian #1 Name *

Parent/Guardian #1 Mobile Number *

Parent/Guardian #1 E-Mail Address *

Parent/Guardian #2 Name

Parent/Guardian #2 Mobile Number

Parent/Guardian #2 E-Mail

What are the best ways to receive information from CCW Youth? *

Other:

Medical/Safety Information

Please List Any Allergies

Tip: If none, please leave blank

Please Select Relevant Dietary Requirements:

Are you able to provide an Anaphylaxis Plan?

Other Dietary Requirements

Does your child have Anaphylaxis? *

Are you able to provide an Anaphylaxis Plan?

Does your child have Asthma? *

Are you able to provide an Asthma plan?

Please note any relevant Disabilities, Injuries or Medical Concerns

Please note any Learning or Behavioural Concerns

Are there any court orders in place regarding your child? *

Please provide details of aforementioned Court Order

Tip: This information will remain highly confidential.

Consent

Do you give Community Church Warragul consent to contact either you or your child about relevant church youth activities via email, text or social media? *

Do you give Community Church Warragul consent to use photos of your child for promotional purposes (E-Mail, Social Media, Website etc) *

By submitting this form I agree to my child/ren attending and participating in Community Church Warragul events and acknowledge that the leaders of all programs conducted by Community Church Warragul will take reasonable care to ensure both the comfort and safety of my child/ren.