YMCA Taranaki Youth Community Army Registration Form

  • YMCA Taranaki Youth Community Army Registration Form

  • Please provide all details to ensure we aware of any health concerns and can contact someone in case of an emergency. Your confidentiality is important to us and it will not be used for any other purposes unless permission is provided. One form per youth will be required. Thank you!

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  • Gender*

  • Ethnicity*

  • Medical Information

  • Have you ever had, or do you suffer from?

  • Any recent injuries, broken bones, or serious injuries*
  • Are you currently taking medication?*

  • Emergency Contact Details

    Please provide name and contact details for at least one other person who can be contacted in an emergency

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  • Your photograph, audio and video recordings may be taken for use in printed publications, online marketing and any other promotional materials for the YMCA. You will not be identified by full name.

  • I agree to the use of photos, videos, and audio of me*
  • After the workshop/activity is finished, I/the youth*

  • Please join the Youth Community Army Facebook Page or the Instagram profile YHubTaranaki to be notified about events.

  • If you wish to be directly contacted with updates please provide permission here:

  • Do you give permission to be contacted about future Youth Army events?*

  • I confirm that all the information I have provided is true and correct to the best of my knowledge. 

    I am aware and satisfied that I am fully aware of the content of this programme. 

    I acknowledge that every precaution will be taken to prevent accidents or unforeseen events from occurring while I attend events as part of the Youth Community Army. I accept there may the possibility of injury or accidents but I accept the responsibility and the YMCA Taranaki, Staff, Volunteers, or other helpers will not be held liable for any injury, damage to property, or loss of property.

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