Bentley Youth Registration | Bentley Baptist Church

All participants that come to Bentley Youth are expected to act towards leaders and other participants with respect, and to do their best to actively participate in any and all activities and do so safely.

After you have completed this form, I will call the number listed for the Parent/Guardian to ensure that the information given is accurate and this form can be used.

Fletcher Heyward

NextGen Pastor

Participant's Name (Required)

Participants Mobile Number (optional)

Participant's Email Address (optional)

Birthday (Required)

Please include year

Food or Other Allergies (Required)

Enter N/A if none

Medical Conditions (Required)

Enter N/A if none

Are there any special considerations that we should know about with your child attending JYG/Bentley Youth?

Your Address

I give permission for Bentley Youth leaders to give medication in an emergency situation (Required)

Medicare Number (Required)

Medicare Reference Number (Required)

I give permission for my child to participate in all Bentley Youth activities, including external activities and being driven to and from external activities by leaders (Green P plates or full license) (Required)

Parent/Guardian Name (Required)

Parent/Guardian Mobile Number (Required)

Parent/Guardian Email (Required)

Solve 9 + 3 = ?

Bentley Baptist Church
59 Chapman Rd, Bentley WA 6102 | admin@bentleybaptist.org | (08) 9458 1628
9.30am Sunday

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