Fusion Registration Form 2020
Registration for Fusion Youth group at MEC
Young Person’s Details
Child’s First Name *
Child’s Last Name *
Address *
D.O.B *
MM
/
DD
/
YYYY
Gender *
Parent’s Email *
Child’s Email (used for weekly communication)
Home Number
Parent’s Mobile *
Child’s Mobile (used for logistics communication only)
Current School Year (or equivalent) *
School name *
Emergency Contact Name *
Emergency Contact Number *
Does your young person have any allergies/medical conditions? *
Details of allergies/medical conditions
If yes above, please give details.
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