Epic Explorers kids holiday program

Epic Explorers kids holiday program

Hosted by Emerald Presbyterian Church
Parent/Guardian details
Parent/Guardian Surname
Parent/Guardian First name
Parent/Guardian phone

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Details

(Additional to Parent/Guardian details above)
Emergency Contact Name and relationship to child
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Consent
Privacy Declaration
I give permission for appropriate photos/videos of my child/ren taken during the program to be displayed in a public place (e.g. church publication, presentation, internet site, approved social media platform) unless I explicitly advise otherwise.
I give permission for the personal details given herein to be provided to appropriate leaders and/or relevant medical/emergency services as deemed necessary.
I understand the details given herein will be used by leaders to contact myself and/or my child/ren and that the details will not be given to any third party, except as provided above.
Authorisations & Expectations:
By completing this form, I hereby give permission for my child/ren to attend all scheduled activities this year, unless we explicitly advise the leadership team otherwise.
In doing so I undertake to provide the leaders with any information relevant to the wellbeing of my child/ren prior to them attending any and all scheduled activities.
I authorise our child/ren to travel in a car driven by an approved leader or an approved parent, unless we explicitly advise the leadership team otherwise. (Your children will not be in a vehicle driven by a learner licence holder.)
I understand that every effort will be made to provide a safe environment, however in signing this form I authorise the leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue or other services considered necessary.
I also acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my child/ren being sent home &/or being temporarily or permanently prohibited from attending the activities of this group.
Child Information
Child 1

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Gender
Grade (note: program is for grades 1-6)
Which school does your child attend?
Days attending program
Does your child have any medical, dietary or care issues that the Ministry Coordinator should know about?
If yes, please detail below:
Is your child subject to a custody order?
Child Medicare number
Position on card
Child 2

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Gender
Grade (note: program is for grades 1-6)
Which school does your child attend?
Days attending program
Does your child have any medical, dietary or care issues that the Ministry Coordinator should know about?
If yes, please detail below:
Is your child subject to a custody order?
Child Medicare number
Position on card
Child 3

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Gender
Grade (note: program is for grades 1-6)
Which school does your child attend?
Days attending program
Does your child have any medical, dietary or care issues that the Ministry Coordinator should know about?
If yes, please detail below:
Is your child subject to a custody order?
Child Medicare number
Position on card
Should be Empty:

Epic Explorers kids holiday program

Parent/Guardian details

Emergency Contact Details

Consent

Child Information