Assyrian Church of the East Youth Association London (Registration Form)

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Name

*

Gender

*

Please select one option.

Male Female

Birthdate

*

Email

*

This address will receive a confirmation email

Mobile phone

*

Home phone

Address

*

Grade

*

Please select one option.

No Grade 7th 8th 9th 10th 11th 12th 13th Graduated

Skills, Experience, Qualifications, and Interests

*

Allergies and conditions

Emergency contact information

Parent's name

*

Parent's mobile phone

*

Note: By submitting this form, I hereby grant permission to ACEYA • London to use photographs and/or videos of me published online, in news and social media platforms and in other communications related to the mission of the Holy Apostolic Catholic Assyrian Church of the East, Diocese of Western Europe.

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