Child Participant Form - Confidential

Dear Parent / Caregiver, to provide the best possible care while your child is with us, please complete the following form.

Personal Details

Contact Details

Medical Information

Tip: (e.g. Bee stings, penicillin, aspirin)

Tip: (e.g. lactose intolerant)

Tip: (e.g. asthma, migraines, dizzy spells, A.D.D.)

Emergency Contact

Please provide contact details should we need to reach you in an emergency.

Tip: The relationship of the person to the child

Tip: The relationship of the person to the child

Safety Information

Tip: Occasionally the church’s ministry areas take photos and videos for promotion and advertising of church activities of which your child might or could appear. For this your approval is required. If you consent to this, please provide your name and signature below

I/we understand that every effort will be made to provide a safe environment for my/our child to participate in.  However, in signing this form I authorise the leaders, in the event of an emergency, to obtain at my/our expense, any medical, ambulance or similar services considered necessary by the leaders.

I/we recognise that being a part of a community involves mutual care and consideration and therefore agree that unacceptable behaviour may result in our/my child being sent home and/or being temporarily or permanently prohibited from attending the student ministry.