Children and Youth Rego

REGISTRATION FOR SUNDAY MORNING YOUTH, KIDS CHURCH OR CRECHE

Participant Details
Name (Participant)*
First Last
Date of birth*
DD slash MM slash YYYY
Program/s attending
- GP Youth (Friday)
- Thrive (Friday)
- Sunday Youth (Sunday)
- Kids Church (Sunday)
- Creche under 5's (Sunday)
School Year
School Year or equivalent for those home schooling
Medical Information
Please list any medical conditions or allergies, and any medication or special care they require. If your child is anaphylactic to any substance please provide information regarding EpiPen and management plan.
Dietary Information
Is there anything your child can not eat and/or drink? Yes or No? If yes, please indicate foods or beverages your child should not consume.
Parent Details
Parent/guardian Name (#1)*
First Last
Parent 1 Phone*
Parent 1 Email*
Parent/guardian Name (#2)
First Last
Parent 2 Phone
Parent 2 Email
Alternate Emergency Contact Phone
Photo Permissions and Medical Emergency
PHOTO PERMISSIONS (Internal purposes)
I permit photos taken of my child to be displayed on notice boards in the church/youth room or other internal purposes.
PHOTO PERMISSIONS (External purposes)
I permit photos or videos taken of my child to be displayed in church publications, e.g. social media, website, newsletters, brochures, etc.
MEDICAL AND LIABILITY RELEASE*
In the event of sickness or medical emergency, I request that my child receive any medical attention or treatment deemed necessary, therefore I give permission to any hospital, doctor, and/or health care provider to transport, treat and/or admit for care my child. I understand that I am responsible for all expenses and charges for the treatment and care of my child. In the event that I am not present at the time of the emergency or cannot be contacted, my care has been entrusted to the staff and designated ministry leadership of Green Point Baptist Church.
Signature of Parent/Guardian:*
Name*
First Last

Children and Youth Rego

Participant Details

Parent Details

Photo Permissions and Medical Emergency

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