HVC Youth Registration
Youth Information
First Name
*
Last Name
*
Date of Birth
*
Gender
*
Male
Female
Youth Mobile Number
Youth Email Address
Age Group
*
0 - 5
6 - 17
18 - 29
30 - 64
65 - 79
80+
School Grade
*
-- None --
Infant - Birth to 1yr
Baby - 1 to 2 yrs
Toddler - 2 to 3 yrs
Preschool - 3 to 4 yrs
Kindy - 4 to 5 yrs
Reception - 5 yrs
1
2
3
4
5
6
7
8
9
10
11
12
Photography Permission
*
Yes
No
Hope Valley Youth Culture Statement
I have read, understood, and agree to the Hope Valley Youth Culture Statement
*
Yes
Parent/Guardian Emergency Contact Information
Parent/Guardian Name
*
Parent/Guardian Contact Email
*
Parent/Guardian Contact Number
*
Medical Information
Do you have any Allergies?
Yes
No
Please provide us with full details of your Allergies/Action Plan.
*
Do you have any Medical Conditions?
Yes
No
Please provide us with full details of your Medical Conditions/Action Plan.
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