St Mary's Parish Youth Group

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Register here for the Parish Youth Group held in the Parish Rooms at St Andrew's, Ravelston. Dates of the meetings will be provided at the first meeting which is the 8th September.

Name of Child *

Date of Birth *

YYYY

Address *

Gender *

Male

Female

Responsible Adult *

E-mail address *

Mobile Phone Number *

Additional Adult details (Name, E-mail address & contact number) *

Any medical conditions, please provide brief details (Condition/treatment) *

Is your child allergic to any medication? *

Yes

If yes, please provide details. *

Name and contact details of family doctor *

Parental consent: Do you agree to the above declaration concerning your child *

Yes

Signature *

Submit

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