One Heart Kid’s Registration

Registrant Name*

First Middle Surname (or family name)

Gender*

Male

Female

Date of birth*

School*

(if not attending type NA)

Grade*

Sacraments of Initiation received*

Baptism

Penance

Confirmation

Eucharist

None

Does your child have a medical condition that we may need to be aware of?*

Yes

Give details of the medical condition*

Preferred Parent Contact*

Mother

Father

Your Name*

First Last

Email*

We will send details for youth activities and any other important information to this email address

Contact Number*

Emergency Contact Name*

First Last

Emergency Contact Number*

Unit Number

Street Name & Number*

Suburb*

State*

By submitting this form, I give consent for my young person to attend Darra Jindalee Children’s Ministry activities and events.

Parent/Guardian Name*

Hidden

Submission Date