Youth Group Young Person Registration Form

Youth Group Young Person Registration Form

Macleay Presbyterian Youth is a program of Macleay Presbyterian Churches where a community of young people from years 7 to 12 come to learn from the Bible who Jesus is and how he changes lives for the better.
Participant Information

Tell us about the participant.
Participant's Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Age*
Gender*
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Participant Phone Number*

Area CodePhone Number
Participant Email Address*
example@example.com
Parent/Carer Information

Contact details for a parent or carer.
1st Parent/Carer Full Name*

First NameLast Name
1st Parent/Carer Phone Number*

Area CodePhone Number
1st Parent/Carer Email Address*
example@example.com
2nd Parent/Carer Full Name

First NameLast Name
2nd Parent/Carer Phone Number

Area CodePhone Number
2nd Parent/Carer Email Address
example@example.com
Is there a current Parenting Order or other legal arrangement regarding this child? If Yes, please send details to mkurilowich@optusnet.com.au.*

YesNo
Emergency Contact Information

In case of emergency, who should we contact?
Emergency Contact Full Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Relationship to Participant (Emergency Contact)*
Medical Information

Details (provide specifics about condition, severity and treatment):
Allergies (food, environment, medications etc.)
Asthma – triggers and medications
Other medical conditions (including mental health)
Any regular medications
Dietary requirements
Administering Medication
Paracetamol: I authorise the leaders of this program to administer one dose of paracetamol to my child as per the instructions on the medication. I understand that this authority is a guideline for administration of a specific dose. I understand the potential risks and side effects of this medication for my child. I understand that when possible, I will be contacted before the dose is given in each specific instance.*

Yes, I give permissionNo, I do not give permission
Does your child have other medications to be administered during the program or activity? (If Yes, a Medication Authority Permission Form must be completed.)*

YesNo
Consent for Images

‘Images’ (photographs and/or video recordings) may be used for general purposes within this program and the church community. All images will be stored securely and used only as stated. Children’s full names will not be used with images unless further parent / carer consent is obtained. If circumstances change, parents / carers can inform us of their wish to withdraw this consent. We will then seek to remove the child’s 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 the information above and consent to my child’s image being used as indicated for internal use - accessible to the church community only*

Yes, I give permissionNo, I do not give permission
I understand the information above and consent to my child’s image being used as indicated for external use - used in material available to the public*

Yes, I give permissionNo, I do not give permission
Consent for Transport

Please review and provide your consent. Any transport arrangements involving leaders of the program must adhere to BTS guidelines, be approved by Session and have a completed Off-Site Event or Travel Permission Form.
I give permission for my child to travel home independently (e.g. walk / public transport)*

Yes, I give permissionNo, I do not give permission
I give permission to the following person other than parent / carer to pick up my child from this program as per a personal arrangement: Person Full Name

First NameLast Name
Person Phone Number

Area CodePhone Number
Relationship to Participant (Person Contact)
Consent for Contact
I understand that unless a Contact and Communication Permission Form is completed, my child will not be contacted by leaders unless there is an emergency situation requiring it. Unless permission is given, contact and communication will occur through parents / carers using the contact details provided.

I understand that any private communications my child initiates with a leader will be shared with the other leaders of the program as a safe ministry measure.
We are a Safe Ministry
Macleay Presbyterian Churches are committed to the biblical call to care for the vulnerable (including children, families, the disabled and elderly). We encourage everyone in our church community to be involved in creating a safe environment for all. We do not tolerate misconduct and abuse.

All our paid and volunteer team members are required to undertake “Breaking the Silence” training which outlines appropriate behaviour, including how to minimise the chances of harm and abuse, as well as how to identify and report cases of abuse. Refresher training is required every three years. In addition, all staff and volunteers involved in Youth Group hold current “Working with Children Check” clearance.

Please see www.breakingthesilence.org.au for more information.
Agreement

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.

I agree that the information contained on this 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.
Signature

Please sign below to confirm the information provided.
Parent/Carer Signature*

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Date Signed*

MonthDayYear
Date
This form will be stored securely by Macleay Presbyterian Churches. If you have any questions or concerns, please contact Bryan on 0404 807 412.
Should be Empty:

Youth Group Young Person Registration Form

Participant Information

Parent/Carer Information

Emergency Contact Information

Medical Information

Administering Medication

Consent for Images

Consent for Transport

Consent for Contact

We are a Safe Ministry

Agreement

Signature