Kids Registration Form

Child's Information

First Name *

Preferred Name

Last Name *

Gender

Date of Birth *

School / College / TAFE / University / Company / Organisation

School Grade *

Guardian's Information

Guardian's full name *

Relationship to child

Email Address *

Mobile Number *

Home Address

Home City

Emergency Contact

Emergency Contact *

Emergency Contact Relationship *

Emergency Contact Number *

Medical & Behavioural Information

Does your child have any known allergies/medical information we need to know about? If YES please fill in below and email any relevant Action Plans to paul.dudley@st-thomas.org.au

Any information that would be helpful for us to know about your child:

Permissions

I give permission my child to appear in photos and/or videos that may be used for St Thomas' promotions

Photo Permission *

I give permission for my child to participate in all children's activities associated with St Thomas' Anglican Church (on the premises or at Civic Park)

Activities permission *

In case of a medical emergency, I hereby give permission to the Doctor chosen by the church authorities or other persons supervising or administering the children's 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.

Permission for hospitalisation, injection, anaesthetic or surgery