Mt Roskill Youth Registration Form 2026 • Mt Roskill Baptist Church

Mt Roskill Youth Group Registration - Mt Roskill Baptist Church

Please note that the information on this form will be used by Mt Roskill Baptist church and youth leaders and is not available to any other individuals or groups. This means that we will not disclose any e-mail address, mobile number or any other details to another individual without your permission. These details will be used to provide:

you, as the parent or guardian, with information about the youth group program, discussion topics, events and issues relating to the wellbeing of your youth
us, as the leaders of Mt Roskill Baptist and Mt Roskill Youth, with information to enable us to encourage and safely care for your youth

Parent or Guardian Contact Details

Primary Parent or Guardian Details

First Name *

Last Name *

Mobile Number *

Email Address *

Home Address

Home Postcode

Relationship to the young person/s you are registering *

What is your relationship to the young person/s you are registering?

Would you like to be part of the Mt Roskill Youth Parent and Guardian WhatsApp group?

Additional Parent or Guardian Contact Details

First Name

Last Name

Mobile Number

Email Address

Home Address if different to above

Relationship to young person/s?

What is their relationship to the young person/s?

Would they like to be part of the Mt Roskill Youth Parent and Guardian WhatsApp group?

Emergency Contact Details

In case of an emergency who would you like us to contact? (Please provide contact details if different to above)

Permissions

Consent *

I agree to the youth named below participating in Mt Roskill Youth and the activities run by the team. I understand that every care will be taken to ensure the health, safety and welfare of my child.

I agree that in the event of the behaviour of the youth/s named below having an adverse effect I will promptly collect (at my cost) them at the request of the organisers

Do you give permission to use photos/videos taken in the course of Youth Group for the Roskill Baptist website, email, and Sunday services? *

Youth Details

Youth 1

First Name *

Last Name *

Date of Birth *

Gender *

Home Address *

School

School Year *

Email Address

Mobile Number

Health and Family Information

Medical Conditions *

Tip: Please list any medical conditions e.g. epilepsy, asthma, diabetes, travel sickness. Type N/A if none applicable.

Social Support and Learning Needs *

Tip: List any social support or learning needs e.g. ADHD, ASD, dyslexia etc. Type N/A if none applicable.

Allergies *

Tip: List any allergies. Type N/A if none applicable.

Mental Health Needs *

Tip: List any mental health needs e.g. depression, anxiety, food disorders, bipolar etc. Type N/A if none applicable.

Custody Information

Tip: List any custody information we need to be aware of

Youth 2

First Name

Last Name

Date of Birth

Gender

Home Address

School

School Year

Email Address

Mobile Number

Health and Family Information

Medical Conditions

Tip: Please list any medical conditions e.g. epilepsy, asthma, diabetes, travel sickness

Social Support and Learning Needs

Tip: List any social support or learning needs e.g. ADHD, ASD, dyslexia etc. Type N/A if none applicable.

Allergies

Tip: List any allergies. Type N/A if none applicable.

Mental Health Needs

Tip: List any mental health needs e.g. depression, anxiety, food disorders, bipolar etc. Type N/A if none applicable.

Custody Information

Tip: List any custody information we need to be aware of

Youth 3

First Name

Last Name

Date of Birth

Gender

Home Address

School

School Year

Email Address

Mobile Number

Health and Family Information

Medical Conditions

Tip: Please list any medical conditions e.g. epilepsy, asthma, diabetes, travel sickness

Social Support and Learning Needs

Tip: List any social support or learning needs e.g. ADHD, ASD, dyslexia etc.

Allergies

Tip: List any allergies

Mental Health Needs

Tip: List any mental health needs e.g. depression, anxiety, food disorders, bipolar etc.

Custody Information

Tip: List any custody information we need to be aware of