Youth Registration • Eternity Church Morwell

Youth Personal Details

First Name *

Middle Name

Last Name *

Preferred Name

Youth Mobile Number

Email Address

Gender *

Date of Birth *

School Grade *

Address

Home Address

Home Address Line 2

Home City

Home Postcode

In Case of Emergency

Emergency Contact 1- Relationship *

Emergency Contact 1 - Name *

Emergency Contact 1 - Number *

Emergency Contact 2- Relationship

Emergency Contact 2 - Name

Emergency Contact 2 - Number

ATTENTION

Anyone not allowed to pick up the child ?

More Info Please

Medical Allergies/ Concerns

Medicare No.

Ambulance Cover

Medical Allergies/ Concerns

Tip: Specify ANY MEDICAL CONDITIONS, INCLUDING allergies, food allergies or other special needs that the child may have, and outline any management plan. (These details will help us care for the children in the best possible way.) If your son/daughter needs any medication during the time they are away from you, this matter should be discussed with the leader prior to the commencement of the activity. Please include pre-existing conditions include TRIGGERS, RESPONSE PLAN, SIGNS and SYMPTOMS to monitor.

Details of Ongoing Medication

Tip: Please include SUBSTANCE, DOSE, FREQUENCY and the NAME OF PRESCRIBING MEDICAL PRACTITIONER

Can the Child Self Administer? *

Yes

Consent

Medical Release *

I agree

I Don't Accept

If during an activity, urgent medical attention is required by my son/daughter and I cannot be contacted, I authorize the relevant leader to take such action as may be necessary and I agree to indemnify Eternity Church Morwell and its leaders from all responsibility relating to the action. An ambulance may be called in the case of a medical emergency, which the parent/caregiver will presume all responsibility for. If an ambulance is called, a parent/caregiver will either travel with the ambulance or meet the child/young person at the hospital. I understand if I fail to neglect to provide sufficient or current information in writing to enable the proper treatment of my son/daughter, no liability will be accepted for any injuries or illness which he/she may suffer as a result.

Drop Off

Authority For a Leader to Drive the Child Home! *

Yes

By clicking I GIVE PERMISSION you agree that the son/daughter mentioned in this form to be driven by a leader who has a driver license where the leader either male or female will be on an active Bluetooth phone line to another leader to ensure open communication is active for leader and youth safety. Furthermore in an event of the son/daughter misbehaving or if their behavior poses a danger to himself/herself or other during this, he/she will be picked up from any destination he/she is in and in such circumstances that you will be informed, any and all cost associated with his/her return will be your responsibility.

Youth & Leader Contact

Do you allow your child to be contacted individually by youth leaders? *

Decline

Weekly Update Texts

would you like to receive weekly updates about youth? *

Decline

Photo/ Video Release

Photo/ Video Release *

Accepted

Decline

I understand that there will or may be photos and/or videos taken of my son/daughter during the activities and am willing for him/her to be so photographed/recorded in appropriate settings. I am also willing for these photos or footage to be used for information and promotional purposes. My son/daughter is also willing for this to take place.

Privacy Statement

Privacy Documents *

Accepted

Decline

We collect and store personal information supplied by you on this form for the purpose of providing a quality program for your son/daughter. This information is not used for any other purpose and is not passed to any other party without your permission.