REGISTRATION & CONSENT FORM FOR YOUTH 7-12

REGISTRATION & CONSENT FORM FOR YOUTH 7-12

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 in Year 7 - Year 12 and/or when your circumstances change.
REGISTRATION
Child's name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Current year at school*

Year 7Year 8Year 9Year 10Year 11Year 12Year 6 (in Term 4)
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.
Consent for Phone/Email Contact
In general, contact and communication by program leaders will occur via parents/carers using the contact details provided above/SCPC database.*

I understand.
I understand that any private communications my child initiates with a leader will be shared with other leaders of the program as a safe ministry measure.*

I understand.
The purpose of any contact or communication directly from program leaders to your child will be for pastoral care (e.g. encouraging your child in the Christian faith, asking for prayer points and to check in on their wellbeing) or for organising program activities (e.g. to invite them to group meetings/events and to confirm attendance).*

I understand.
In line with advice on practicing safe ministry a minimum of 2 WWCC/BTS leaders will observe the communication at all times, no active communication will take place after 10PM or before 6AM and leaders will follow the same safe ministry practices that are expected in person: accountability, transparency and exercising wisdom. We encourage you to monitor any interaction we have with your child as you see fit.*

I understand.
I give permission for my child to be contacted by appointed program leaders via post, group email and/or group chat as is appropriate. I understand leaders will speak with me before including my child in group emails/chats.*

Yes, I give permission.No, I do not give permission.
Child's mobile
Optional.
Child's email
Optional.
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/youth 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 90min for Youth) 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
Year 7 to 9 Program (during Sunday gatherings) Permission
A program for years 7-9 youth is run during our Sunday gatherings during term time. Your child will leave the main gathering at the appointed time and will return to the morning tea area at the appointed time. A minimum of 2 WWCC/BTS compliant leaders will be present at all times and they will follow safe ministry practices of accountability, transparency and exercising wisdom.*

I understand.
I give permission for my child to attend the Year 7 to 9 program during our Sunday morning gatherings.*

Yes, I give permission.No, I do not give permission.
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 YOUTH 7-12

REGISTRATION

Medical Information

PERMISSIONS

Consent for Images

Consent for Phone/Email Contact

Online Meeting Permission

Year 7 to 9 Program (during Sunday gatherings) Permission

PRIVACY

SIGNATURE