Kids + Youth Ministry Registration Form 2024

Dear Parents/Carers,

This form registers your child/children for one or more of the groups we have for kids + youth:

- Creche (under school age) Sundays during 10:00am Church
- Kids Church (Kindersgarten-Year 5) during 10:00am Church
- Teens@Church (Year 6-8) during 10:00am Church
- SHAPE (Year 9-12) Sundays 4:30-6:00pm
- Illuminate Youth (Year 7-12) Fridays 6:30-8:30pm

Please fill out this form for each of your children attending one of our kids + youth groups.

Thanks for taking the time to make sure we can care well for your child.

Child Details

First Name *

Last Name *

Gender

Date of Birth *

Home Address *

Home City *

Home State *

Home Postcode *

School Name

School Grade

Parent / Carer 1 Details

Parent/Carer 1 Name *

Parent/Carer 1 Phone Number *

Parent/Carer 1 Email Address

Parent / Carer 2 Details

Parent/Carer 2 Name

Parent/Carer 2 Phone Number

Parent/Carer 2 Email Address

More Child Details

Emergency Contact Person (other than parents/carers)

Emergency Contact Phone Number

Emergency Contact Person's relationship to child

Doctor Name

Doctor Phone Number

Medicare Card Number

Medicare Card Reference Number

Medicare Card Expiry Date

Health Insurance Company

Ambulance Membership

Yes

Date of last tetanus booster

Please outline any medical / special needs / allergies that it would be helpful for leaders to know about

Please list any persons legally restricted from seeing the child

If you are happy for leaders to contact your child in accordance with Safe Ministry policy then please provide:

Child's Mobile Number

Child's Email Address

I give permission for photos/video of my child to be used in published church media *

Yes

Name of person who submitted registration form

Date of registration form submission

PERMISSION AUTHORISATION
Completion of this form indicates my willingness to permit my child to participate in kids + youth group activities organised by Kurrajong & North Richmond Anglican Church.
In the case of a medical emergency, I hereby give permission to the Doctor chosen by the church authorities or other persons supervising or administering the kids + youth activity, to secure proper treatment for and/or order hospitalisation, injection, anaesthetic, or surgery for my child as named. I understand that every effort will be made to contact me prior to instituting such procedures.

ADDITIONAL DETAILS:
The information provided on this form will be treated in accordance with our organisation's privacy policy. The youth leadership team will treat the information confidentially. Information may be shared with a third party in the case of emergency medical help. If you wish to access this information or have any queries in relation to the manner in which we handle it please contact us.