Arise Youth Registration Form

Parent/Guardian Details:

Parent / Guardian Names: *

Email Address

Primary Contact Mobile: *

Home City

Emergency Contact Name / Relationship (Other than parent)

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Mobile

Child Details

First Name *

Last Name *

School Grade *

Dietary Requirements

Child Mobile

Date of Birth

Allergies

Disabilities

medical information:

It is a requirement of our Child Protection Policy that as a parent / guardian - you come into the church to sign your child/ren in and out every week for Youth. If this is not possible on occassion please contact the youth leader to confirm other arrangements.

Safe check in committment *

Please indicate if you are happy for your child to be given Paracetamol if needed?

Paracetamol permission

Is your child authorised to be taken to hospital in an emergency?

Ambulance to Hospital permission *

I give permission for my child to travel by in a Youth Leaders Car to youth outings (if no, please talk to a youth leader)

Travel by bus or car to youth outings *

I give permission for a youth leader to contact your child outside of youth as part of our mentoring program (Within our Child Protection Policy guidelines)

Youth leader contact permission

I give permission for my child's photo/video to be taken for Internal use only and within the guidelines of our Child Protection Policy.

Photo / Video permission