Children and Youth Registration Form

Parent/Guardian Details

Parent/Guardian #1 -Primary Contact

Tip: Occasionally we may wish to send you 'happy mail', relating to your child.

Parent/Gardian #2

Additional Emergency Contact

Child's Details

Special Permisions

Tip: Are you happy for photographs to be taken with your child in them, and then to be used in any promotional material for the program your child attends?

Tip: Do you give permission for your child to leave the St. Mark's premises supervised by program leaders? This applies more to youth programs.

Medical Information

Tip: Do you agree to St. Mark's staff and volunteers administering first aid to your child or calling in a medical professional to treat your child in case of a medical emergency involving your child?

Tip: Does your child have any special needs it would help us to know about?

Tip: Is there any further information you would like to tell us about your child?