EmailMe Form - Children & Youth Information Form 2019

Student Information

Please answer the following section with details about the young people attending the youth programs

Student 1 Name *

First Last

Date of Birth *

DD / MM / YYYY

School attending & Grade in 2019: *

Student 1: I would like to register for:

Ignite Kids (Sunday Morning)

Boyzone

Girlzone

Ignite Youth- Junior & Senior (Grades 6-12)

Student 1 Medical / Allergy Information:

Please include details of symptoms and management procedures.

Student 2 Name

First Last

Date of Birth

DD / MM / YYYY

School attending & Grade in 2019:

Student 2: I would like to register for:

Ignite Kids (Sunday Morning)

Boyzone

Girlzone

Ignite Youth- Junior & Senior (Grades 6-12)

Student 2 Medical / Allergy Information:

Please include details of symptoms and management procedures.

Student 3 Name

First Last

Date of Birth

DD / MM / YYYY

School attending & Grade in 2019:

Student 3: I would like to register for:

Ignite Kids (Sunday Morning)

Boyzone

Girlzone

Ignite Youth- Junior & Senior (Grades 6-12)

Student 3 Medical / Allergy Information:

Please include details of symptoms and management procedures.

Parent / Guardian Information

Parent/Guardian Name(s) *

Address *

Street Address City State / Province / Region Postal / Zip Code

Primary Contact Number *

Secondary Contact Number

Primary email address

This email will be used to send electronic copies of programs etc.

How would you like to receive program information? *

Post

Email

Text

Please tick as many as you would like

Emergency Contact Information

Please list someone not already listed above.

For Ignite Kids please lsit the name and contact details of the adult that your child attends church with if they don't come with a parent/carer

Name *

First Last

Relationship to young person *

Primary Contact Number *

Secondary Contact Number

For Friday Night Programs Only - Boyzone, Girlzone, Ignite Youth (6-8) and (9-12)

Is there any other information that could help us in looking after your child?

Please include information about custody arrangements etc. if appropriate

Extra Permissions

Please tick the box if you DO NOT give permission for your child's picture to be used in this way

I DO NOT give permission

At Youth Events photos or videos may be taken. These media items may be used in sensitive & appropriate ways for promotional material of the church. This includes but is not limited to, brochures, websites, PowerPoint presentations, displays, advertising and other printed/electronic material.

I give permission for my child to be driven by Church approved “P Plater” drivers for youth activities* NOT COMPULSARY

Yes

No

I allow my child to be their own signatory for sign in/out (Grade 11+ Only)

Yes

No

Consent Section

By submitting this form you are consenting to the following:

I consent to the leaders acquiring for this child medical services necessary in the event of an emergency; and agree to pay all associated medical expenses incurred on behalf of this child.
I give permission for my child to participate in Children & Youth Group activities that may include but is not limited to: trips around the local area with church approved drivers*, water activities, bonfires, ball sports and others. I understand that by my child attending youth events, consent has been given for them to participate in the activities planned.
Please note: Certain events will require separate permission forms.
I understand that my child needs to be signed in and out of events by an adult

For any issues or questions regarding these policies please contact Iain Anderson on:
Mobile - 0429694343,
Church office - 64243441 (Tuesdays & Fridays)
Email - yowie@devonportcoc.com.au

Contact details for person filling form out

Please note that this form must be filled out by the student's legal parent/guardian.

Name of person who completed this form *

First Last

Phone number of person completing this form *