Youth Hub Client Registration • INFINITY CHURCH

Child First Name *

Child Last Name *

Date of Birth *

Home Address

Languages Fluently Spoken

School Currently Attending

School Grade

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email *

Parent/Guardian Phone Number *

Are you registering for Tutoring, Participation in Themed Activities or Both?

Tutoring Area(s) Needed:

Teaching English as a Language

Maths

Reading Skills

Writing Skills

Tutoring Availability

Tip: Please select which dates your child will attend tutoring sessions

Preferred Tutoring Start Time *

Tip: Tutoring sessions take place in 30 minute intervals beginning from the selected start time

Which Extra-Curricular Theme(s) of Interest will your child attend?

Tip: All activities to begin at 10:30am

Additional Information About the Child We Should Know:

Reason for Joining the Program:

Do you have resources for tutoring or need resources supplied?

Allergies

Medical Conditions

Special Learning Needs

Photo/Video Consent *

Yes

No

Tip: I give permission for image/video of my child to be captured and used for materials and marketing related to this program.

Consent & Privacy Agreement *

Agree

Disagree

Tip: Read Policy here: https://www.inc.org.au/privacy-policy