Child Registration

Registration for Kids' Club and Youth Group To provide the appropriate care and supervision, we require some information and permission. These details will be treated confidentially within our team. Thanks!

Your name *

Email address *

Primary Carer

Your own details

Phone number *

Address *

Emergency Contact(s)

Details of other adults who may be contacted in case of emergency. Note, please don't list yourself as we need at least one additional emergency contact.

Emergency Contact Name (1) *

Emergency Contact Phone (1) *

Emergency Contact Email (1)

Emergency Contact Name (2)

Other Adult(s)

Details of other adults who may collect your child(ren) at the end of the program.
If there are people who may NOT collect your child(ren), please also note that here.

Full Name(s) and Phone Numbers

Child(ren) details

Details of your child(ren)

Full Name *

Date of Birth *

School year *

Child's phone number

Medical information *

Please describe any medical or psychological conditions that require special attention that we should know about, e.g. diabetes, asthma, allergies, hearing or sight impairment, ADHD, behaviour issues, formal counselling situations, etc.

Add another child

Permissions

Photos & videos *

I agree that appropriate photographs and/or videos of my child(ren) taken during public church events such as Music Time, Kids' Club, Youth Group, and Sunday Church may be used for information or advertising (for example, on the website or in a brochure).

Collection *

I understand that an adult named above must collect my child(ren) before they are allowed to leave the site.
If you require your child(ren) to make their own way home or somewhere else, please give all the details below.

Collection *

If you answered "yes" above, please type "n/a".
If you answered "no" above, please list: Where they are going, how they are getting there (e.g. on foot, bike, scooter), who will be responsible for them (at least one name and phone number), any other details.

Safety & risk *

I understand that leaders will take all reasonable care to ensure the comfort and safety of my child(ren) and that there is still a risk that an injury or accident may occur.

Signature *

Type your full name to sign this form. Thank you, and we look forward to seeing you and your child(ren).