Rev Youth - Permission Form

Permission Form

Revolution Youth
Thank you so much for taking the time to fill in this form for your child. It's really important to us that Revolution Youth is a place where everyone who comes along feels safe and knows what to expect as they arrive; you providing this information to us is really helpful in making sure we can achieve that for your child.

If you have any trouble or questions at all regarding this form, please contact Ben Sterland at ben@communitylife.org.au. Thank you!
Young Person's Information
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
School Grade*
Parent/Guardian Name (1)*
Contact Email (1)*
example@example.com
Parent/Guardian Name (2)
Contact Email (2)
Home Address*

Street Address

Street Address Line 2

SuburbState

Postal Code
Does your child have any dietary requirements?*
If yes, please indicate foods or beverages your child should/must not consume
Does your child have any medical conditions?*
If yes, please list any medical conditions or allergies, and any medication or special care they require.
Emergency Contact Information
Emergency Contact Name (1)*
Mobile Number (1)*
Relation to Child (1)*
Emergency Contact Name (2)*
Mobile Number (2)*
Relation to Child (2)*
Declarations

If you would like more information on any of the following, please don't hesitate to get into contact with Ben
Photography - Do you authorise for photos of your child to be used on the church website, on church social media profiles or on printed materials?*

I doI do NOT
Medical Treatment*

By selecting this box - I authorise suitably trained leaders and medical professionals to administer appropriate medical treatment (e.g. first aid, use of ambulance etc.) to my child and understand that I will be notified as soon as possible. I accept responsibility for expenses associated with such treatment.
Liability*

By selecting this box - I affirm my understanding that all duty of care will be taken by leaders for my children and they will not be liable for any misadventure.
Declaration*

By marking this box and submitting this form I declare that I am the parent or legal guardian of the young person mentioned above. All information provided is accurate and up to date, and I reaffirm all permissions granted.
Your Name*
Relation to Child*
Permission Form Signed Date*

DayMonthYear
Signature*

Clear
Should be Empty:

Permission Form

Young Person's Information

Emergency Contact Information

Declarations