Youth Information

Personal Information

Tip: If your child has a mobile phone, you can provide us with their number, if you both wish to do so.

Home Address

To protect your child from possible embarrassment, but not to exclude them from the program, the following information is required:

Medical Concerns / Allergies

Emergency Contacts


By submitting this form, you agree to the following:

Please note that if you fail or neglect to provide sufficient and current information in writing to enable the proper treatment of your child, no liability will be accepted for any injury or illness, which your child may suffer as a result. An ambulance may be called in the case of a medical emergency, which the parent/caregiver will presume all responsibility for. If an ambulance is called, a parent/caregiver will either travel with the ambulance, or meet the child/young person at the hospital. I give permission for Portlife Church to supervise and provide first aid (if necessary) for my child. I give permission for my child to travel by all modes of public and private transport whenever the need arises. I also allow my child to participate in ALL events completed at Portlife Church and at any other location. The above information is correct and I give permission for Portlife Church to provide supervision for my child in accordance to its Child Protection Policy.