South Coast Life Church
Kids and Youth Registration Form
Child Information
Full Name
*
First Name
Last Name
Date of Birth
DD-MM-YYYY
Child's Academic Year 2026
Please Select
Not yet attending school
Preschool
Kindergarten
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
I am registering my child for:
*
Let's Play
Little Berries
Big Berries
Kids Club
Berry Youth
Parent/Guardian Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Emergency Contact Information
Please provide two emergency contacts
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Medical Information
Are there any foods or beverages that your child cannot consume?
*
Yes
No
If yes, please specify:
Does your child have any allergies or medical conditions requiring medical attention or special care?
*
Yes
No
If yes, please specify:
Authority
I authorise the leaders of the group to arrange for my child to receive any such first aid and medical treatment as a trained first aid person may deem necessary:
*
Yes
No
I authorise the leaders of the group to call an ambulance for my child in case of an emergency:
*
Yes
No
I accept responsibility for payment of all expenses associated with such treatment:
*
Yes
No
I give permission for my child to participate in activities outside of the normal meeting complex where they are within a reasonable walking distance:
*
Yes
No
I permit photos of my child to be displayed in church publications eg social media, website, newsletters, brochures etc:
*
Yes
No
I give permission for my child to be transported in a private car as arranged by the leaders of the group:
*
Yes
No
If I am unable to collect my child at the finishing time, they may be transported home with the following people:
*
Submit
Should be Empty: