JAFFA Registration Form

Child's Information

First Name *

Preferred Name

Last Name *

Gender

Date of Birth *

Home Address

School *

School Grade *

Primary guardian

Parent's full name *

Relationship to child *

Email Address *

Mobile Number *

Secondary guardian

Full name

Relationship to child

Best contact number

Email address

Emergency Contact

This person will be contacted if we can't reach any parents/guardians.

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? Email any relevant Action Plans to JAFFA@st-thomas.org.au. *

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

Permissions

I give permission for my child to walk with leaders from NSDS or Shore to St Thomas' Anglican Church after school. *

Authorised nominees who may collect child *

Tip: Please list any people other than yourself who are allowed to collect your child after Jaffa

I give permission for my child to leave at the end of JAFFA by *

Walking home independently

Picked up by nominated person

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) *

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 *

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