Paper Chains Registration

please tick which group depending on your year.

PaperChains [Year4-6]

Date of Birth *

First Name *

Last Name *

Gender *

Email Address

Demographics

Adults

Families

Youth

Children

Tip: Please tick Children

Home Address *

Home Address Line 2

Home City *

Home Country *

Home Postcode *

Tip: e.g Town3610, Rural3681, Waihi Beach 3611.

Phone Number *

Parent / Guardian *

Email Adress *

Mobile Number *

Parent / Guardian

Email Adress

Mobile Number

Medical Information. Are there any Medical information we need to know about? and is your child on any medication?

Any Medication should be handed into the main leader and it will be supplied when needed, if the medication needs to be carried by your son/daughter please come and let us know. All information will be kept confidential, we cannot accept responsibility for any information not declared. *

I, the Parent/Guardian declare all this information is correct

From time to time we may travel to Morgan Park, town etc. for activities, these activities will always include an adult/leader to be with the young people. Below declares that you allow us to transport your kids to these activities. *

I, The Parent/Guardian give permission for my child to leave the premises with a Waihi Baptist youth Adult/Leader.

Thank you for taking the time to fill out the form. This is to ensure that we have your contact details to keep you informed and to allow us to communicate with you.

My Contact details

Joni Kuizinas

Leader

Waihi Baptist Church

3 Gimour Street

(07) 863 6263

(022) 024 5039

jonikuizinas@yahoo.com