Children/Youth Registration

Children/Youth Group Registration

Child/Youth Details

First Name *

Last Name *

Date of Birth *

Gender *

Parent's Mobile Number (or Youth's Mobile Number) *

Address *

Suburb *

Post Code *

Is your child at school? *

Yes

School Grade (if applicable) *

School Name *

Allergies

Food Allergies *

None

Nuts (Mild)

Nuts (Severe)

Coconut

Salicylates

Amines

Egg

Fish

Shellfish

Molluscs

Coeliac

Gluten Intolerent

Wheat Intolerant

Dairy

Lactose (Intolerant)

Other Food Allergies

Carries Epipen *

Yes

General Allergies *

None

Penicillin

Asthma

Dust Mites

Mosquito Bites

Grass

Hayfever

Allergic Rhinitis

Band Aids

Latex

Other General Allergies

Carries Ventolin *

Yes

Further Information on allergies or special needs that will assist leaders.

Group Registration *

SUNDAY 9:15am groups

SUNDAY 11:15am groups

IGNITE - Years 3-6 (Friday Night)

CRECHE @ Wednesday Women (0-5y)

PLAYCIRCLE (Mon AM)

SALT - Years 7-12 (Friday Night)

Tip: Please indicate which group/s you are registering for.

For Sunday groups: Parent Attend Church while child attends Group?

St Paul's Service attended

Tip: Please select which service/s apply.

Family Details (Emergency Contact Details)

Main Contact:

Parent/Guardian Name: *

Mobile Number *

Email Address *

2nd Contact - In Case of Emergency:

Parent/Guardian Name: *

Tip: Someone who could be contacted in case of an emergency.

Mobile Number *

Photo Permission

I give the following permission: Photos and Videos may be used for St Paul's Anglican programmes and services and/or for advertising purposes. *

The information collected on this form will be used for the purpose of arranging this St Paul’s ministry activity. It will be disclosed to St Paul’s staff members and will be handled in accordance with our Privacy Policy. By completing this form, you indicate your consent for us to collect, use and disclose the information you have provided above in this manner.