Youth Rush Registration Share hope from the doorstep Registration Youth Rush Registration First Name * Last Name * Email * Subscribe to the Stories of Faith e-newsletter * Yes No Residential Address * Mobile Number * Date of Birth * Gender * Female Male Age * Why would you like to canvass this summer at a Youth Rush event? * What type of work or study are you engaged in? Name of school, university or workplace How did you hear about Youth Rush? * Would you be interested to learn more about a Gap Year for Jesus or applying for a scholarship? Yes No Which local church do you attend? * Conference * Greater Sydney North New South Wales Northern Australia South Australia South New South Wales South Queensland Tasmania Western Australia Victoria Pastor name * Pastor phone * The following parent/guardian information is required for students under 18 years. Parental consent given Yes No Parent/Guardian name Additional Parent/Guardian name Parent/Guardian address Parent/Guardian phone If you are human, leave this field blank. Submit
