GBC Youth Registration V2 • GBC Links

Hello and welcome to GBC Youth. We are so excited to have you here. For the safety of your youth we are required to have a parent/guardian fill out this permission and information form. This information is all confidential and is used to keep you child safe.

Youth/Child's Information

First Name *

Date of Birth *

Home Address

Home Address Line 2

Last Name *

School Grade *

Home City

Home Postcode

Additional Information

Does your child have any allergies (including food intolerances), medical conditions, or behavioural concerns? *

If yes, please explain allergies (including food intolerances), medical conditions, or behavioural concerns.

Is there anyone in which your child should not be allowed to leave a GBC program with? *

Tip: If yes, you will be contacted by the Youth Coordinator for further details.

Do you give permission for your child to leave and make their own way home following the end of the program? *

Do you consent to your child being photographed? *

Tip: Photos which are taken may be used for GBC social media and not for personal accounts.

Do you consent to your child receiving first aid and medical treatment as a trained first aid person may deem necessary? *

Do you authorise the calling of an ambulance in an emergency and accept responsibility for payment of all expenses associated with such treatment? *

Parent/Guardian Emergency Contact Details

Emergency Contact 1

First Name *

Mobile Number *

Relationship *

Last Name *

Email Address *

Emergency Contact 2

First Name *

Mobile Number *

Relationship *

Last Name *

Email Address *

Parent/Guardian Declaration

By adding my name and date, I consent to my child participating in GBC Youth activities. I am aware that this may include follow up procedures that may include social media, phone calls and messages, or face-to-face with the GBC Youth Leadership Team. I am aware that should I wish for information regarding GBC policies in this area, I can ask the Youth Coordinator to provide me with this information.

Parent/Guardian Full Name

Date