Youth Registration Form 2019/2020
Welcome to the Youth Registration Form! This form is a key part of our safeguarding policy, and will help us best serve the young person.

It needs to be completed by the Parent/Carer of the young person, and shouldn't take longer than 5 minutes. We will need one form completing for every young person.

All data submitted will be processed and held in line with Data Privacy regulations, which can be found via our website, gasstreet.org

If you have any questions please do get in touch with James Leavy (Kids & Youth Pastor) at youth@gasstreet.org
Email address *
Child's Name *
Your answer
Child's Home Address *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
School Year *
As of September 2019
Child's Mobile Number
Sometimes we will send a text to the young people to let them know about Gas Street Youth News. Messages are sent at appropriate times for information purposes only. By giving us their mobile number you are consenting to us contacting them.
Your answer
Groups Your Child Attends/Interested In
For more information on the below groups head to gasstreet.org/youth
Emergency Contact - Name *
Your answer
Emergency Contact - Relationship to Child *
Your answer
Emergency Contact - Number *
Your answer
Additional Emergency Contact - Name *
Your answer
Additional Emergency Contact - Relationship to Child *
Your answer
Additional Emergency Contact - Number *
Your answer
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This form was created inside of Gas Street Church. Report Abuse - Terms of Service