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Parent/Guardian Details

Please note that this person is also the emergency contact for your children

First name(Required)

Last name(Required)

Phone

Email(Required)

Child 1 Details

Child 1 Full Name(Required)

Child 1 Date of Birth(Required)

Day

Month

Year

Child 1 Allergies, Medical Requirements and Notes

Are you registering a second child?

Yes

No

I consent to recieve marketing and event information details via text message or email

I consent to photos/videos to be taken of my child for internal and marketing use

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Perth
Pentecostal
Assembly

+61 (0) 467786163

Locations

contact@ppachurch.au

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