Holiday Bible Club Kids Consent Form
Please review and sign to confirm your child’s participation and permissions for the program. Tuesday 13th - Thursday 15th October
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Address
Street Address
Street Address Line 2
City
Country
Post Code
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child's Primary School Year
Please Select
Primary 1
Primary 2
Primary 3
Primary 4
Primary 5
Primary 6
Primary 7
Details of Family Doctor
*
Name of Practice
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Email Address
*
example@example.com
Does your child have any allergies or medical conditions?
*
No
Yes (please specify below)
If yes, please provide details of allergies or medical conditions
Do you give consent for your child's picture to be taken and shared on social media?
*
Yes
No
Submit Consent
Should be Empty: