TDYC Reg Form

Youth Club Registration Form
Thank you for your interest in attending our Youth Club - we hope you have a great time with us. Please make sure that your parent/guardian/carer completes this form to ensure we have all the information we need to keep you safe whilst you are here at the Centre.
Participant Details:
Name*

First NameLast Name
Gender:*
Date of Birth:*

MonthDayYear
Date
Mobile Number (if they have one):
Address*

Street Address

Street Address Line 2

TownState / Province

Post Code
Who is their Emergency Contact?*
What is their relationship to the participant?*
How can we reach them?*
How can we reach them?
E-mail address:*
Collection/Drop-off details:*

Unless notified, a parent or guardian will be dropping off and collecting my child from each sessionI give permission for my child to walk to and from each session
Which school year are they in/will they be in this year? (Yrs 6, 7, 8, 9 ,10, 11, or 12)*

Youth Club Registration Form