Parent/Youth Email Address:
Parent/Youth Mobile Phone:
Parent 1 Name:
Parent 1 Mobile Phone:
Parent 2 Name:
Parent 2 Mobile Phone:
Please list special needs, allergies, health concerns:
Is the emergency contact information the same as Parent 1?
You have my permission to use photos of me in any Trinity parish publication/s.
Do you want to receive period emails about Whole Community Learning which may include other children, youth and family programs?
How did you hear about this event?: