24/7 Youth Registration Form

Student Information

Student Contact Details

It is our ChildSafe policy to always attempt to contact legal parents, guardians and/or carers first, to get their permission to contact students directly. 

Tip: Email addresses are extremely helpful to know also!

Safety and Care Details

Parent & Emergency Contact Information

In case of an emergency, please list the phone numbers where you and a freind or relative may be contacted during the course of the program.

Tip: Email addresses are extremely helpful to know also!

Tip: Please list someone other than the parent listed above who we might contact (if necessary) in an emergency.

Medical Information

Are there any medical of psychological conditions which require special attention that we should know about e.g. diabetes, asthma, allergy to bee-sting, other allergies including food, hearning or sight impairment, ADHD, behaviour issues, formal counselling situations, or any other? Please list below:

Tip: Please enter the individual reference number for the student.

Please note that in regards to non-prescription medications such as paracetemol (e.g. Panadol), it is our policy that team members and leaders do not provide medications.

Medical History

Consent to Collect

Who will collect you child(ren) at the end of the program? Please nominate yourself or another trusted adult: