Student Details
First Name
Last Name
Gender
Male
Female
Date of Birth
Mobile Number
School Grade
-- None --
Babies
Toddlers/Pre Kindy
Kindergarten
Pre Primary
1
2
3
4
5
6
7
8
9
10
11
12
Allergies
Nuts
Gluten
Dairy
Bee Stings
Seafood
Other Dietary / Medical needs
Parent Contact
Parent/Guardian Name
e-mail
mobile
Parent Contact
Parent/Guardian Name
e-mail
mobile
Permissions
I give permission for my child to attend Epic Youth @ Church of Christ Albany
Yes
I understand that EPIC Youth Leaders will contact me should behavioural or medical issues arise
Yes
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