Youth Enrolment Form 2026 • Port City Christian Church

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Youth Program - Enrolment Form

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About Your Child

First Name *

Last Name *

Date of Birth *

Gender *

School Grade

Mailing Address

Mailing Postcode

Medical & Custody Information

Do any of the following apply to your child?

Medical Condition

Behavioural/Mental Health Condition

Allergies

Dietary Requirements

Custody Arrangement

Please select all Medical Conditions that apply:

Please select all Behavioural/Mental Health Conditions that apply:

Please select which Custody Arrangement applies:

Please select all Allergies that apply:

Please select all Dietary Requirements that apply:

Please provide relevant details for any listed conditions

Parent/Guardian Information

Parent/Guardian 1 - Full Name *

Parent/Guardian 1 - Relationship to Child

Parent/Guardian 1 - Mobile Number *

Parent/Guardian 1 - Email *

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Parent/Guardian 2 - Full Name

Parent/Guardian 2 - Relationship to Child

Parent/Guardian 2 - Mobile Number

Parent/Guardian 2 - Email

Consent

Please read the CHILDREN AND YOUTH PROGRAM CONSENT 2026 information

I have read the conditions and I give permission for my child to:

Participate in the Program *

Yes

Recieve Medical Treatment if Required *

Yes

Sign themselves out at the end of the program *

Yes

Contact Consent *

Yes

Transport arrangements to and from Youth Events *

Parents to drop and collect

Approved adult to drop and collect

Independent Travel (Youth will make their own way)

Photo and Media Consent *

Yes

Communication & Care

Email Communications I would like to receive *

Youth (e.g. Term Plan, Offsite event information)

Upcoming Church Events (e.g. visiting preachers, Christmas play)

General Church Mailing List