MAC Youth Registration Form - 2016 • Macquarie Anglican

MAC Youth Registration Form - 2016

Thanks for your interest in MAC Youth at Macquarie Anglican! Please fill out this form to register your child for this group for 2016.

Child's Details

First Name *

Last Name *

Gender *

Date of Birth *

Street Address *

Suburb *

State *

Postcode *

Home Phone Number *

Family Email Address

Youth Email Address

Youth Mobile Number

Emergency Contact Details

Please provide the details of at least two people whom we could contact in case of an emergency. We recommend that at least one (or both) of these be a parent, and the second could be a relative or friend.

Emergency Contact 1 Type *

Tip: This must be either a parent or guardian

Emergency Contact 1 Name *

Emergency Contact 1 Number *

Tip: If possible please provide a mobile number as we will use this for SMS updates (i.e. cancellations, last minute updates etc)

Emergency Contact 2 Type

Tip: This can be a parent, guardian, or someone else you nominate

Emergency Contact 2 Name

Emergency Contact 2 Number

Tip: We will only use this number for SMS if it is a parent or guardian.

Things that are helpful for us to know

School Grade *

School

Medical Conditions (e.g. physical, mental health and safety needs)

Tip: i.e. do you require us to administer any medication to your child during MAC Youth Meetings?

Restrictions

Tip: i..e. are there any other details that you think we should know to ensure your child is happy and safe attending MAC Youth regularly? (eg. allergies, restricted activities, phobias, etc?)

Please read the following, and submit form.

By accepting these conditions and submitting this form I indicates my willingness to permit my child to participate fully in activities associated with MAC Youth from the 1st January 2016 till the 31st December 2016 at Macquarie Anglican.

In the case of a medical emergency, I give my permission for a doctor chosen by a Macquarie Anglican leader or other person supervising the programme 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 agree that the information included on this form can be used by leaders of MAC Youth or any other authorised person supervising MAC Youth for the purposes of MAC Youth. I also acknowledge and agree that any photographs or video of my child taken while participating in MAC Youth may be used by the church to promote further youth activities (for example, during a church services, on church premises).

Acceptance of conditions *

Yes thats fine!

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

Your name *