Bentley Baptist Church

Bentley Youth Registration

All participants that come to JYG/Bentley Youth are expected to act towards leaders and other participants with respect, and to do their best to actively participate in any and all activites and do so safely.

After you have completed this form, I will call the number listed for the Parent/Guardian to ensure that the information given is accurate and this form can be used.

Fletcher Heyward

NextGen Pastor

Participant's Name (Required)

Participants Mobile Number

Participant's Email Address

Birthday (Required)

Please include year

Food or Other Allergies (Required)

Enter N/A if none

Medical Conditions (Required)

Enter N/A if none

Are there any special considerations that we should know about with your child attending JYG/Bentley Youth?

Your Address

I give permission for Bentley Youth leaders to give medication in an emergency situation

Medicare Number (Required)

Medicare Reference Number (Required)

I give permission for my child to participate in all JYG/Bentley Youth activities, including being driven to and from activities by leaders (Green P plates or full license) (Required)

Parent/Guardian Name (Required)

Parent/Guardian Mobile Number (Required)

Parent/Guardian Email

Bentley Baptist Church

59 Chapman Rd, Bentley WA 6102