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,
If you have any questions please do get in touch with James Leavy (Kids & Youth Pastor) at
Child's Home Address
Child's Date of Birth
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.
Groups Your Child Attends/Interested In
For more information on the below groups head to
SUNDAY : Youth @ 11:30 // 11.30 - 1pm (Year 7 - 13)
SUNDAY : Youth Café // 5:30 - 6pm (Years 9 - 13)
THURSDAY: Youth Space // 3.15 - 5.30pm (Years 7 - 11)
THURSDAY: Youth @ 7 // 7 - 8.30pm (Years 7 - 13)
Emergency Contact - Name
Emergency Contact - Relationship to Child
Emergency Contact - Number
Additional Emergency Contact - Name
Additional Emergency Contact - Relationship to Child
Additional Emergency Contact - Number
Never submit passwords through Google Forms.
This form was created inside of Gas Street Church.
Terms of Service