Children's and Youth Program Enrolment Form 2019

This is the form to fill in to enrol a child into Emu Plains Anglican Church children's/youth programs. Items with a red asterisk '*' must be completed. 

If you have more than one child, select  'Add Another Person' at the bottom of the form and common information will be auto-filled

Child's Basic Details

Parent/Guardian/Family Details

Please provide at least one phone number - and if possible, include one on which you can be reached during the program time.

Other Information

Tip: Please provide someone other than a parents / guardians already listed above, in case they cannot be contacted

Tip: Please indicate Yes or No.

Tip: Please indicate Yes or No.

Submission Details

By entering my name and today's date below, I confirm that the details provided in this form are accurate: