membership form

For health and safety reasons we are asking all youth who come to Whakatipu Youth Trust’s drop-in and programmes to become a member first. We are also asking that all previous members to please sign up again so that we can update their details on our database.

We require this form to be filled in by both the youth wishing to become a member and their parent or legal guardian. The purpose of this form is for us to maintain a central database of contact, medical and consent information for day-to-day activities in and around the centre and to ensure both parents/guardians and the youth are aware of the rules and standards of behaviour within our community.

Please fill out the details below to become a member.
If you have any problems get in touch with us or download and complete the form.

Youth's Details
Youth's Name
Date of Birth
Youth's Phone Number
Ethnicity
Which school does your youth attend?
Parent / Step Parent / Relative / Legal Guardian
Person must be aware they are the primary emergency contact. Must be over 18 years of age.
Primary Emergency Contact Name*
Primary Emergency Contact Phone Number*
Primary Emergency Contact Email*
Secondary Emergency Contact Name
Secondary Emergency Contact Phone Number
Medical Information
It is important that you provide us with as much information as possible regarding any medical conditions, special needs or dietary needs. In the event an emergency contact cannot be reached, WYT reserves the right to seek medical attention for your youth at your cost
Doctors Name*
Doctors Phone Number*
Whakatipu Youth Trust is an all inclusive and non-judgemental environment. For the best support of your child please let us know if your child has any Medical or Mental Health Conditions/Behavioural Needs/Medication/Allergies/Special Needs/Dietary Requirements?
- Yes
- No
Will your youth be carrying medication with them throughout the course of the programme/activity?
- Yes
- No
Photo Consent
Permission to use your child/ren photo on WYT website, WYT social media, media outlets or WYT promotional material*
- Yes
- No
How did you hear about us?
How did you hear about us?
Terms and Conditions
Terms and Conditions*
- I agree that I have read and understand the Terms and Conditions

membership form

membership form

Membership Form

Youth's Details

Parent / Step Parent / Relative / Legal Guardian

Medical Information

Photo Consent

How did you hear about us?

Terms and Conditions

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