Kids Permission 2023

First Name *

Last Name *

Preferred Name

Date of Birth

Gender

School Grade *

Home Address

Home Address Line 2

Suburb

Postcode

State

Parent/Guardian 1 *

Parent/Guardian 1 Mobile

Parent/Guardian Email

Parent/Guardian 2

Parent/Guardian 2 Mobile

Emergency Contact Name *

Relationship to child *

Mobile Number *

Medical Information

Medical Advice for the Child

Child Medical Note 1 - Critical Issues (if none, add Nil) *

Child Medical Note 2 - Allergies & Intolerances

Child Medical Note 3 - Other health/behaviour issues

Additional Notes

Medicare #

Number on card

Are there any family or custody issues that we should be aware of? If yes, please make contact with James Jensen to discuss *

Privacy Statement

I/we give permission for appropriate photos/videos of my child/ren to be taken at Christ Central Kids programs to be displayed in a public place (eg. church plublication, presentation, internet site, approved social media platform) unless I explicitly advise otherwise.

I/we give permission for the personal details given herein to be provided to appropriate Christ Central Kids leaders &/or relevant supervisory/medical/emergency services personnel as deemed necessary.

I understand the details given herein will be used by Christ Central Kids leaders to contact myself &/or my child/ren & that the details will not be given to any third party except as provided for above.

Authorisation and Expectations

I/we hereby give permission for my child/ren to attend all Christ Central Kids activities and programs unless I/we explicitly advise otherwise.

In doing so I/we undertake to provide the Christ Central Kids leaders with any information relevant to the wellbeing of my child/ren prior to them attending any & all scheduled Christ Central Kids programs.

I/We understand that every effort will be made to provide a safe environment for my/our child/ren to participate in. However, in signing this form I/we authorise the leaders, in the event of an emergency, to obtain at my/our expense, any medical, ambulance, rescue or other services considered necessary.

I also acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my child/ren being sent home and or temporarily or permanently prohibited from attending the activites of this group.

Photography Approved for the Child *

Ministries Approved for the Child *

I understand that by ticking the box below that this is in place of my written signature and gives my permission and authorisation.

Permission and Authorisation *

I agree

Date permission given *