Vine Youth Registration Form

Thanks for your interest in Vine Youth at Macquarie Anglican! Please fill out this form to register your child for this group.

Child's Details

First Name *

Last Name *

Street Address *

Suburb *

State *

Postcode *

Home Phone Number *

Gender *

Date of Birth *

School Grade *

School

Church attended (if any)

Medical and Care Needs

Does your child have any medical conditions/allergies we should know about?

Tip: i.e. chronic illness, allergies, dietary restrictions, medication we should know about?

Is there anyone who is legally restricted from seeing your child?

Is there anything else we should know about in caring for your child's needs?

Tip: i.e. behavioural concerns or restrictions, mental health needs (i.e. depression), etc.

Family and Emergency Contact Details

Parent/Caregiver 1

Name *

Relationship to child *

Preferred phone number *

Tip: Providing a mobile number is helpful as it allows us to send updates by SMS

Email Address *

Parent/Caregiver 2

Name

Relationship to child

Preferred phone number

Email Address

Emergency Contact (alternative to parents/caregivers)

Name *

Relationship to child *

Preferred phone number *

Privacy & Child Safety

Macquarie Anglican is committed to doing everything we can to ensure the physical, emotional and spiritual welfare of all who participate in our activities. You can read our Child Safety policies & procedures here.

We respect your privacy. When you provide us with personal information by participating in church events/activities, visiting a website, or otherwise, you agree to this personal information about you and your children (under 18 years old) being handled as set out in our privacy policy.

The personal information in this form will be made available to the SALT Youth Leaders, who will treat this personal information confidentially. The personal information in this form may also be shared with medical and emergency services if considered necessary.

Authorisations and Expectations

By accepting these conditions and submitting this form I permit my child to participate fully in activities associated with Vine Youth at Macquarie Anglican.

In a medical emergency, I give my permission for a doctor chosen by a Macquarie Anglican leader 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.

I also acknowledge and agree that any photographs or video of my child taken while participating in Vine Youth may be used by the church to promote further youth activities (i.e. during a church service, on church premises).

I understand that teens attending Vine Youth should be dropped off and collected by a parent/authorised adult, and that they must be signed in each week.

I confirm that the information given in this form is correct, and will advise the Vine Youth leadership of any changes to this information.

Acceptance of conditions *

Yes that's fine!

No - I'd like to discuss this with one of the ministry staff

Your name *