KIDS - Registration Form • Menai Baptist Church

MBC CHILDREN'S INFORMATION & CONSENTS FORM

CHILD'S DETAILS

First Name *

Preferred Name

Last Name *

Date of Birth *

School Grade

What year did/does your child start school? *

Home Address *

Home Address Line 2

Post Code: *

Email Address

PARENTS' DETAILS:

First Name: *

Last Name: *

Home Phone:

Mobile Number: *

Email Address: *

Relationship *

Parent

Guardian

Other

First Name:

Last Name:

Home Phone:

Mobile Number:

Email Address:

Relationship

Parent

Guardian

Other

EMERGENCY CONTACT/S (other than listed above)

Emergency Contact 1

Emergency Contact 2

(Emergency Contact ) First Name *

(Emergency Contact ) Last Name *

(Emergency Contact ) Mobile *

Relation to Person *

(Emergency Contact 2) First Name

(Emergency Contact 2) Last Name

(Emergency Contact 2) Mobile

Relation to Person

MEDICAL:

Regular Doctor's Name and Contact Details:

Medicare Number:

Medical Conditions: Does your child have any medical conditions, allergies or extra developmental needs we need to be aware of? Please provide details

Dietary Requirements: Does your child have any dietary requirements?

CONSENTS:

Medical Treatment Consent: *

Yes

Tip: I being the parent/guardian of the above child(ren) understand that whilst every precaution will be taken to ensure the good welfare and protection of my child(ren), Menai Baptist Church (MBC), its staff and volunteers acting on behalf are hereby released from any and all liability in the event of any accident or misfortune, damage or loss that may occur to the child(ren) or their property. In the case of an emergency, I hereby give permission to the First Aid Staff to ensure proper treatment for my child(ren). I understand that every effort will be made to contact me before instituting such procedures. I agree to pay all such doctor, ambulance and hospital fees incurred on behalf of my child(ren). I have detailed any health information about my child(ren) that the First Aid Staff need to know.

Involvement Consent *

Yes

Tip: I being the parent/guardian of the above child(ren) hereby give my consent that my child(ren) may participate in any activities they choose over the course of the MBC Kids and MBC Youth.

Photography and Video Consent *

Yes

Tip: I being the parent/guardian of the above child(ren) hereby give my consent for my child(ren) to be captured in both photographs and video at MBC Kids and MBC Youth. Menai Baptist Church reserves the right to use this material for promotional purposes.

Signature: *

Date: *

Thank you for providing this important information. The safety and wellbeing of your child is our primary concern.