Youth Registration • Reveal Church

Personal Details

Child First Name *

Child Last Name *

Gender *

Date of Birth

School Grade *

Child Mobile number

Phone Number

Tip: If your child has a mobile phone, you can provide us with their number, if you both wish to

Email Address

Home Address

Unit/ House Number

Address

City

State

Postcode

To protect your child from possible embarrassment, but not to exclude them from the program, the following information is required:

Medical ID

Medical Concerns / Allergies

Tip: Specify ANY MEDICAL CONDITIONS, INCLUDING allergies, food allergies or other special needs that the child may have, and outline any management plan. ( These details will help us care for the children in the best possible way.) If your son/daughter needs any medicine or tablets during the time they are away from you , this matter should be discussed with the leader prior to the commencement of the activity.

Medical Release *

Please accept by ticking the box

If during an activity, urgent medical attention is required by my son/daughter and I cannot be contacted, I authorize the relevant leader to take such action as may be necessary and I agree to indemnify Reveal Church and its leaders from all responsibility relating to the action. An ambulance may be called in the case of a medical emergency, which the parent/caregiver will presume all responsibility for. If an ambulance is called, a parent/caregiver will either travel with the ambulance, or meet the child/young person at the hospital. I understand if I fail to neglect to provide sufficient or current information in writing to enable the proper treatment of my son/daughter, no liability will be accepted for any injuries or illness which he/she may suffer as a result.

Emergency Contacts

Parent/Caretaker Emergency Contact 1 - Full Name *

Relationship with the Youth/Child - Contact 1

Parent/Caretaker Emergency Contact 1 - Phone No. *

Parent/Caretaker Emergency Contact 1 - Email

Parent/Caretaker Emergency Contact 2 - Full Name

Relationship with the Youth/Child - Contact 2

Parent/Caretaker Emergency Contact 2 - Email

Parent/Caretaker Emergency Contact 2 - Phone No.

Are there any people NOT Authorised to pick up your children?

Permissions

Photo/Video Release

Photo/ video Release

I accept

I do NOT accept

I understand that there will or may be photos and/or videos taken of my son/daughter during the activities and am willing for him/her to be so photographed/recorded in appropriate settings. I am also willing for these photos or footage to be used for information and promotional purposes. My son/daughter is also willing for this to take place.

Privacy statement

Privacy statement *

Please accept by ticking the box

We collect and store personal information supplied by you on this form for the purpose of providing a quality program for your son/daughter. This information is not used for any other purpose and is not passed to any other party without your permission.

BY FILLING OUT THIS FORM :-

I acknowledge that my son/daughter has permission to be involved in regularly scheduled activities as advertised in the church calender and/or other publications. I will ensure that a leader is in attendance before leaving my son/daughter at any program session. I will accurately complete any "sign in/out procedures at the program" that may be available at the program session (only you, or the person authorized by you on this form, will be able to collect your child at the end of this session.) I will collect my son/daughter as soon as possible at the conclusion of any program session. I will attend to, collect or remove my son/daughter immediately if requested to do so for reason misbehaviors, illness, injury or any other emergency situation. I will also allow my son/daughter to participate in all events at Reveal Church and at any other locations.