Child Details
First Name
*
Last Name
*
Date of Birth
*
Email Address
*
Gender
*
Male
Female
Phone Number
Mobile Number
School Grade
*
-- None --
Baby 0-1
Toddler 1-2-3
Pre-Kindergarten 3-4
Kindergarten 4-5
Prep
1
2
3
4
5
6
7
8
9
10
11
12
Personal/Family safety issues?
*
Yes
No
Medical issues?
*
Yes
No
Are there any dietary requirements or allergies (e.g Lactose intolerant etc)?
*
Yes
No
If yes, please provide details:
If yes, please give details:
If yes, please give details dietary or allergies:
Parent/Guardian Details
Parent or Guardian First Name
*
Primary Phone Number
*
Address
*
Parent or Guardian Last Name
*
Email
*
Relationship to Child
*
Suburb
Postcode
Parent or Guardian 2 First Name
Phone Number (Parent or Guardian 2)
Address (Parent or Guardian 2)
Parent or Guardian 2 Last Name
Email Address (Parent or Guardian 2)
Relationship to Child (Parent or Guardian 2)
Suburb
Postcode
Permissions
Permission to transport:
*
Yes- All license types (Red & Green P's)
Yes- Green P's & Opens
Yes- Opens only
Not at all
Permission for your child's/children's photo to be used for ministry or promotional purposes on Discovery Youth social media/church website?
*
Yes
No
Permission to take photos:
*
Yes
No
Permission to contact child for youth/church related things via:
*
Phone
Email
Social media
No contact
Signing out
*
Permission for my child to sign themselves out of youth
Permission (written or verbal) for someone else to sign out my child
Only I (parent/guardian) have permission to sign out my child
Please specify who has permission to sign out your child if applicable:
Any other important information we need to know:
I understand that if my child requires any form of medication (e.g Asthma Puffer, Epipem, prescrition medication) it is my responsibility to ensure that my child arrives with the necessary medication clearly labelled and that the leader is aware.
*
Yes
I agree that in the event of a medical episode, emergency medical assistance can be immediately sought if necessary, and I agree to be responsible for any costs associated. I understand every attempt will be made to contact me in the event of an emergency, but understand that the welfare of my child is paramount.
*
Yes
I understand that certain inherent risks and dangers may exist in activities in which my child will be participating. I acknowledge that while Wynnum Baptist Church will make every reasonable effort to minimise exposure to known risks, that all dangers cannot be foreseen or may be beyond the control of Wynnum Baptist Church, its leaders and staff. I understand that Wynnum Baptist Church will take all responsible care of my child while at the program, and that Wynnum Baptist Church will not be liable in any injury or accident, or for damage or loss of property.
*
Yes
I recognise that being a part of a community involves mutual care and consideration and therefore agree to follow the rules and guidelines of Discovery Youth and that unacceptable behaviour may result in my child being sent home.
*
Yes
I AGREE TO ABIDE BY WYNNUM BAPTIST CHURCH'S COVID RESTRICTIONS AND KEEP MY CHILD AT HOME IF THEY PRESENT ANY FLU/COLD SYMPTOMS
*
Yes
I confirm that all information contained in this application is true and correct and agree to inform Wynnum Baptist Church of any changes to these details.
*
Yes
Date form completed:
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