MEGA Jaffa Registration Form

Child's Information

First Name *

Preferred Name *

Last Name *

Gender *

Date of Birth *

School / College / TAFE / University / Company / Organisation *

School Grade *

Parent's Information

Parent's full name *

Relationship to child *

Email Address *

Phone Number

Mobile Number *

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 here.

Allergies, Medical Information and Conditions *

Does your child have any known behavioural conditions we should know about?

Behaviour *

Permissions

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

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

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 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 *