Harvest Youth Group Full Registration

Please fill out this form and click submit.

Junior Youth: Grades 5-8
Senior Youth: Grades 8-12

Youth Information

First

*

Date of Birth

*

School Grade (For 2025-2026)

*

Please select one option.

K 1 2 3 4 5 6 7 8 9 10 11 12

Contact Phone Number

Contact Email Address

Personal Health Number (BC Care Card)

*

Allergies/Medical Conditions

Do you currently attend a church?

Please select one option.

Yes No

If so, what church do you currently attend?

Other Information

Primary Caregiver Information

Primary Caregiver Name (First and Last)

*

Primary Phone Number

*

Primary Email Address

*

Alternate Phone Number

Parent / Legal Guardian Info (if different from Primary Caregiver)

Legal Guardian Name (First and Last)

Legal Guardian Phone Number

Legal Guardian Email Address

Emergency Contact Information

In case of emergency we will attempt to reach the Primary Caregiver first, then the Parent or Legal Guardian if different from Primary Caregiver. This emergency contact info will only be used if we cannot reach either of those.

Emergency Contact Name (First and Last)

*

Emergency Contact Phone Number

*

Relation to the Youth

*

Consent to using photographs and videos of your child for promotion and social media.

*

Please select one option.

Yes No

Description

Please fill out this form and click submit.

Junior Youth: Grades 5-8
Senior Youth: Grades 8-12

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