State Youth Games 2022 • York Street Church of Christ

CHILD (PRIMARY SCHOOL + YOUNGER) 0

NOTE THAT YOU NEED TO COMPLETE BOTH THE YORK STREET FORM AND STATE YOUTH GAMES FORM. (YOU WILL BE REDIRECTED FROM HERE)

It is a requirement of STATE YOUTH GAMES, that all persons over the age of 18 are to supply a Working with Children Check.

Students in years 8 and above are welcome to attend State Youth Games, however, years 6 and 7 students are welcome with an accompanying parent or guardian.

Youth must be 13 years old and in year 7 to participate in sports activities.

For any questions or clarification contact: converge@yorkst.com.au

REGISTRATION DETAILS

First Name *

Gender

Age

Email Address *

I give permission for representatives of Converge Youth to administer first aid and/or call an ambulance in the case of an injury/emergency: *

Last Name *

Date of Birth *

School Grade

Mobile Number

Do you give permission for your photos/video to be taken and used for promo material? *

WWCC Number

Medicare Number *

WWCC Expiry Date

Emergency Contact Name

Emergency Contact Mobile

Emergency Contact Relationship

Emergency Contact Email

YORK STREET CHURCH OF CHRIST STATE YOUTH GAMES 2022

Date & Time

CHILD (PRIMARY SCHOOL + YOUNGER) 0

REGISTRATION DETAILS

EMERGENCY CONTACT