Youth Group Enrolment Form 2025 • Cornerstone Church

Welcome to Cornerstone Youth 2025!

To keep our information up to date - please complete this form for each child that would like to enrol in Cornerstone Youth.

Emergency contact numbers for our Youth Coordinators are

Caleb Nelson - 0274 520 009

Renee Sayal - 021 661 350

Hannah Rempala - 020 4120 6440

Child Details

First Name *

Last Name *

Date of Birth *

Gender *

Home Address *

Dietary needs or allergies

Other health information that you would like us to be aware of

Notes or additional info you'd like us to know

Parent/Guardian Details

Primary Parental Contact (name & number) *

Primary Parent's Email Address *

Secondary Parental Contact (name & number)

Second parental contact email

Emergency contact name and number

Tip: E.g. Grandparent / adult sibling / family friend - name and number

Consent

I consent to my child participating in the Cornerstone's Youth Group programs.

Consent given by *

Tip: please enter your name

Date *

Additional Consent

First Aid - I give permission for my child to receive first aid as necessary such as ice, Panadol, plasters etc. *

Permission to use photos/video of your child (Cornerstone may occasionally use these photos/videos for internal use and/or publicity) *

Persmission for Supervisor to 'Sign in and Out' your child on arrival / departure

At the end of a regular youth function: *

I give permission for my child to leave the venue without a parent/guardian.

I ask that my child waits at the venue for a parent/guardian or someone I notify you of.

In addition to my child's parents/guardians, I give permission for the following named people to pick-up my child (eg. older sibling John Smith, friend Joe Blogs, Grandparents Mark and Sue Smith.) I will notify a Leader if I arrange someone not on this list.

Is there anyone legally restricted from seeing your child?

Tip: If yes, please list full name(s).