Harvest Youth Group Full Registration

Please fill out this form and click submit.

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

If you or your youth have never filled out a registration form with Harvest Youth, please fill out this form. This is for the safety of you or your child and so we can communicate future events with you.

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 Mobile Number

Contact Email Address

How would you prefer communication?

Please select all that apply.

Email Text Either Both

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 Mobile Number

Primary Email Address

Alternate Phone Number

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

Legal Guardian Name (First and Last)

Legal Guardian Mobile 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 Mobile 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

Harvest Youth Group Full Registration

Description

Please Fix the Following