Clone of Rise Youth 2025 Registration Form

Rise Youth - Participant Registration Form

Please complete all fields of this form. Contact the team if you have any questions, riseyouth@lifestreamscc.com
Protecting your privacy is important to us. The information we seek allows us to manage risk, provide reasonable care and administer your involvement in our program. We are careful to keep your information confidential and provide it only to those agents acting on behalf of the organisation who need it to enable them to perform their agreed activities (e.g. First Aid officer). We will not use your information for other purposes. You are welcome to contact our office in relation to issues regarding your personal information and for a copy of our Privacy Policy.

We only ask for information that is necessary for the purposes outlined in this statement. In some circumstances if you don’t provide us with all requested information you could miss the opportunity to be involved in our program.

Participant Information
Participant First Name*
Last Name*
Birth Date*

DayMonthYear
Gender*
School Year (2026)*
School Name

Parent / Guardian Contact Information
Parent First Name*
Last Name*
Relationship to Participant*
Email*
example@example.com
Phone Number*
Please provide primary number for contact

Emergency Contact Details
Emergency Contact Name*
Primary Contact
Emergency Contact Number*
Primary Contact
Emergency Contact Relationship to Participant*
Primary Contact
Emergency Contact Name
Secondary Contact
Emergency Contact Number
Secondary Contact
Emergency Contact Relationship to Participant
Secondary Contact

Program and Activity Details
Does the participant have any dietary requirements:*

YesNo
If 'Yes', please provide details:
Throughout the program, the participant may be engaging in a range of general sporting and recreational activities. Are there any activities that you do not wish the participant to participate in?*

YesNo
If 'Yes', please provide details:
Please list the person(s) authorised to pick-up the participant from the program and/or any custody arrangements that the team needs to be made aware of:*
Please include first and last name of authorised person(s)

Authorisation, Release & Indemnity by Parent or Guardian
Do you consent to appropriate use by us of photographs, video and audio taken during the program that include the participant? For example: use on our web page, social media or in a brochure?*

YesNo
I   First Name   Last Name  give my permission for my child First Name   Last Name  to participate in the Lifestreams Christian Church Rise Youth program in 2026.

At Rise Youth, we accept duty of care for a child attending Rise Youth program. We have risk management and policies & procedures in place to keep your child safe. Please contact us if you’d like more information about these policies & procedures.

In consideration of Lifestreams Christian Church Inc allowing my child to take part in the Activities:

a)    I agree, to the extent permitted by law, to absolve, release, discharge and indemnify Lifestreams Christian Church Inc. its employees and volunteers (“LCC”) from any and all liability for any injury, loss or damage to our child however caused, arising out of our child’s participation in the Activities, including without limitation, where caused by an acts of negligence by LCC;

b)    I agree to indemnify LCC from any and all liability for any injury, loss or damage to LCC or any other person resulting from an act of omission of my child during the Activities;

c)    I authorise LCC to consent on my behalf, where it is impractical to communicate with me, for my child/children to receive medical treatment deemed necessary. I accept responsibility for payment of all expenses associated with such treatment including ambulance fees.
By signing below I acknowledge that I have read and agree to the statements above.
Signature of Parent/Guardian*
Should be Empty:

Rise Youth - Participant Registration Form

Participant Information

Parent / Guardian Contact Information

Emergency Contact Details

Medical Information

Program and Activity Details

Authorisation, Release & Indemnity by Parent or Guardian