REGISTRATION & CONSENT FORM FOR CHILDREN P-6

REGISTRATION & CONSENT FORM FOR CHILDREN P-6

In line with our commitment to safe ministry practices, the information collected in this form will be used by appointed program leaders and stored securely by Southern Cross Presbyterian Church.
PLEASE NOTE

Throughout this form, the terms 'WWCC' and 'BTS' are used. 'WWCC' = Working With Children Check and 'BTS' = Breaking the Silence (safe church training of the Presbyterian Church in NSW).

Please complete this form if your child is aged Preschool - Year 6 and/or when your circumstances change.
REGISTRATION
Child's name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Current year at school*

PreschoolKindergartenYear 1Year 2Year 3Year 4Year 5Year 6
Parent/carer #1*
Full name
Relationship to child*
Phone Number*
Please enter a valid phone number (mobile preferred).
Email*
example@example.com
Parent/carer #2
Full name
Relationship to child
Email #2
example@example.com
Phone Number #2
Please enter a valid phone number (mobile preferred).
Family address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is there a current Custody Order or other legal arrangement regarding this child?*

YesNo
Please attach any relevant custody details below.

Cancelof
Medical Information
My child has a medical condition, allergy, asthma, anxiety and/or dietary requirements.*

Yes (if 'yes' please outline below)No
Please provide specific details about condition, allergy, asthma, anxiety and/or dietary requirements (including severity, regular medications and treatment/management).
Emergency contact (other than parent/carers listed above)*

First NameLast Name
Relationship to child*
Phone Number*
Please enter a valid phone number (mobile preferred).
By signing at the end of this form, I authorise the leaders of this program, in the event of an emergency, to obtain at my expense any medical, ambulance or similar services considered necessary.*

Yes, I authorise.
PERMISSIONS
Consent for Images
At Southern Cross Presbyterian Church (SCPC), we use photos and videos taken at our various activities and events to promote and celebrate our ministries. ‘Images’ (photographs and/or video recordings) may be used both internally and externally for publications and materials including (but not limited to) church family news, advertising materials, church family publications, church website and other online platforms. All images will be stored securely and used only as stated. Please note that names will never be included with images.*

I understand.
If circumstances change, you can inform us of your wish to withdraw this consent. We will then seek to remove the image where it appears in digital formats but may not be able to retract printed material. Individuals may also request specific images be removed.*

I understand.
I give permission for images containing my child to be used both internally and externally for SCPC publications and materials including (but not limited to) church family news, advertising materials, church family publications, church website and other online platforms.*

Yes, I give permission.No, I do not give permission.
The consent given for 'images' will operate until I expressly revoke it.*

I understand.
Online Meeting Permission
In light of the circumstances created by global pandemics (such as COVID-19), ZOOM/online meetings may be held in place of normal kids ministries in the unlikely event that a lockdown occur. In line with advice on practicing safe ministry online a minimum of 2 WWCC/BTS compliant leaders present at all times, a set timeframe (no longer than 30min for P-6) and leaders to follow the same safe ministry practices that are expected in person: accountability, transparency and exercising wisdom. Should a lockdown occur, the relevant kids/youth program leader will be in contact with parents and provide details for ZOOM online meetings.*

I understand.
I give permission for my child to participate in online meetings during a lockdown.*

Yes, I give permission.No, I do not give permission.
I agree to monitor my child’s online interactions appropriately whilst they participate in online meetings.*

YesNo
PRIVACY
Personal information collected is used only for purposes relating to the spiritual, pastoral, social, educational, administrative, legal and historical functions of the Church subject to the Church‘s Privacy Policy in accordance with the Privacy Amendment (Private Sector) Act 2000. Your acceptance of this written advice will be regarded as your consent to collect and so use the information as described. If you do not consent please advise immediately. A copy of the Church‘s Privacy Policy is available on the PCNSW website or upon request. Personal information will not be used for any other purpose without first obtaining your consent. PLEASE CHECK ALL before continuing.*

I agree that the information contained on this Child Registration Form is true and correct.I agree that I will ensure that any changes to this information are advised in writing as soon as possible.I understand the consent given in this form will operate until I expressly revoke it.
SIGNATURE
Name*

First NameLast Name
Please select from the following:*

I would like to sign on the screen below.I would like to upload my signature.
Please sign on the screen here:*

Clear
Please upload signature here:*

Cancelof
Date*

DayMonthYear
Date
Should be Empty:

REGISTRATION & CONSENT FORM FOR CHILDREN P-6

REGISTRATION

Medical Information

PERMISSIONS

Consent for Images

Online Meeting Permission

PRIVACY

SIGNATURE