Sign up for youth group

Home Address *

School Name

Emergency Contact Full Name *

Emergency Contact Phone Number *

Emergency Contact Email Address *

Do you have any physical and/or emotional needs that we should be aware of to best support you? *

Tip:

Please describe your medical condition *

Please describe your allergy or dietary requirement *

Please descibe your mental health *

Please descibe your custody arrangements *

In a few short words, why would you like to join WB Youth?

Tip: Here are a few examples of things you can write: make friends, socialise, spiritual support, emotional support, mentoring, etc.

Would you like one of our youth leaders to contact you?

Yes

No

I give permission for this information to be added to the Church database. *

Yes

Tip: This information is only accessible to church staff and key leaders, and is stored digitally on our secure database.

I give permission for Waikanae Baptist to contact me with the above information. *

Yes

I want to receive regular updates about youth group via email. *

Yes

No