VILLE Youth Registration • Kellyville Anglican

Parent/Guardian Details

Parent/Guardian #1: Full Name *

Parent/Guardian #1: Mobile Number *

Parent/Guardian #1: Email *

Parent/Guardian #1: Home Address

Child Details

First Name *

Last Name *

Date of Birth *

Mobile Number

What school does your child attend? *

If the school is not listed, please type it here

School Grade *

What group will your child be attending? *

VILLEX (School Yrs 5&6)

VILLE Youth (School Yrs 7-12)

Permissions

Does your child have allergies? *

Yes

If yes, please provide allergy details in the following box. Otherwise, leave blank

Is there anything that would be helpful for us to know in caring for your child (impairments, behavioural issues, prescription medication, chronic illness, special diets etc)? *

Yes

If yes, please provide helpful details in the following box. Otherwise, leave blank.

Can we take photos and/or video of your child? We love showing people what happens at our church so these images can be used in our communications (including online) in promotion of our church and its' activities. *

Yes

After submitting this form, you will be directed to Kellyville Anglican's PushPay page to process your child's youth rego fees.

The amount set is per child and you can pay either: termly OR yearly (for a discounted rate).
On PushPay, we've set the default to a yearly payment. If you'd like to do a term-by-term payment, select "Youth Term Payment" from the dropdown box under "Give one time" and adjust the amount accordingly.

Thanks for taking the time to fill this out, we look forward to seeing your child on Friday nights!