Youth Contact Information Form

In submitting this form, are you: *
--- Select --- Providing your Information for the First Time (Please complete entire form). Updating Existing Information (Please complete Name, Date of Birth and then only new or changed information).

First Name *

Surname *

Parent's Names *

Parent's Surname *

Your Gender
--- Select --- Male Female
Date of Birth

/

/

Country of Birth
Street Address
Suburb
Postcode
Home Phone
Mobile Phone
Email *

Previous Church
Date you began regularly attending Epic Youth
Name of School
School Year level
Life Group Leader's Name
Do you come to CityLife on the weekends?
--- Select --- Yes No
Do your parents attend CityLife Church?
--- Select --- Yes No
Do they support you attending?
--- Select --- Yes No
Do you live at home with:
--- Select --- Both Parents Just Mum Just Dad Other Which Congregation do you primarily attend?
---- Select ---- Casey Knox Knox Cantonese Knox Mandarin Manningham Melbourne City Online Whittlesea
Is there any information, medical or otherwise, which would help the Youth Leader?
Additional Comments