SIXOH Youth New Person Form • Dreambuilders Church

First Name *

Last Name *

Gender

Date of Birth *

Parent / Carer Name *

Parent/ Carer Phone Number *

Parent/ Carer Email Address *

Secondary Contact Name *

Secondary Contact Number *

Home Address

School

School Grade

Dietary Requirements

Nil

Gluten Free

Diabetic

Dairy Free

Tip: Please let team know if you have any other requirements not in this field.

Medical Conditions

Do you attend Dreambuilders Bunbury Church? *

I consent for my child to attend SIXOH Youth Activities. *

Yes, I give my consent.

I acknowledge that my child will receive first aid or access to emergency services if required. *

Yes, I acknowledge

I give consent for photo / videos including my child to be used in SIXOH Youth / Dreambuilders, Bunbury social media, publications and promotion. *

Yes