Parent or Guardian First Name *

Parent or Guardian Last Name *

Email Address *

Primary Phone Number *

Address

Suburb

Parent or Guardian 2 First Name (optional)

Parent or Guardian 2 Last Name (optional)

Parent of Guardian 2 Mobile Number (optional)

What activity/ministry are you registering for? You can select more than one. *

What is your preferred method of contact (updates, kids events etc)? You can select more than one. *

I understand that my child's photo may be used for ministry or promotional purposes *

Tip: If you have any concerns regarding this please email kids@wybc.org.au to discuss

First Name *

Last Name *

Preferred Name

Date of Birth *

Gender *

School Grade *

School (optional)

Contact Name *

Relationship to Child *

Emergency Phone Number *

Are there any medical or developmental conditions that may affect your child's safety or engagement with the program (e.g. Hearing or visual impairment, ADD, ASD or ADHD)? *

If yes, please give details:

Tip: To help your child access and enjoy the programs to their fullest, a leader may be in contact to discuss their individual needs

Are there any dietary requirements (e.g Lactose intolerant etc)? *

If yes, please give details:

Does your child have any allergies (e.g. bee stings, penicillin, nuts etc) ? *

If yes, please give details:

Does your child suffer from asthma? *

If yes, have they required hospitalisation in the past?

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. *

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. 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. *

Tip: Please contact kids@wybc.org.au if you have any concerns