Please complete a seperate form for every child you wish to register.

Parent/Guardian Details

First Name

Last Name

Email

Phone number

Address

Are you working with the DCP?

Yes

No

Child's Details

Child's Name

Date of Birth

Gender

Medical Information

YMCA SA works hard to provide safe, supported and enjoyable camps and activities. Please help us to meet this goal by providing us with as much information about medical, health, behavioural and dietary issues or concerns as you can. Our staff are very happy to discuss any additional requirements or support that is needed.

Does your child have any allergies and/or any dietary requirements?

Yes

No

If yes, please provide more information.

Does your child have a Behaviour Support Plan?

Yes

No

If yes, please provide a brief outline below.

Please email a copy of the complete plan to sayouth@ymca.org.au

Does your child have any conditions or issues that may affect your participation in this activity?

Yes

No

If yes, please provide more information.

Please email any relevant documentation to youth@ymcasa.org.au on completion of this application.

Further Details

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Email

Image Consent

I agree for my child's photograph to be taken, acknowledging that it may be reproduced in print and electronic format for YMCA South Australia promotional activities. I understand that I may request in writing for my child's photograph no longer be used in future print or electornic media.

Around The World Registration Form

Y-Connect Around The World Registration Form

Parent/Guardian Details

Child's Details

Medical Information

Further Details

Image Consent