PenCC Kids Registration Form 2026

Child Registration Form 2026
Please select one of the following
Name

First NameLast Name
DOB
Gender
Grade
School if applicable
Address

Address

Street Address Line 2

SuburbState / Province

Postal / Zip Code
Postcode
Please upload a photo of your child - please note this photo will only be used for our check-in system and Medical/additional needs paperwork (if required).

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Does this child have any medical conditions or allergies?

Medical/Allergy Management Action Plan 2026
Medical Condition/Allergy
Causes Trigger signs or symptoms
Treatment / Medication
Is this child/young person able to self-administer treatment
Any additional information
Please upload a copy of your child's management plan if they have one.

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Additional Needs Information
Current diagnosis medical condition or learning difference
Triggers Signs and Symptoms
Strategies or approaches to support child please include activities your child enjoys and or activities they need extra help with
Any additional information

Is there anything else the leaders should know about your child?
PARENT / GUARDIAN DETAILS
Parent/Guardian 1
Name

First NameLast Name
Date of Birth
Phone Number
Please enter a valid phone number.Format: 0000 000 000.
Email
example@example.com
Parent/Guardian 2
Name

First NameLast Name
Date of Birth
Phone Number
Please enter a valid phone number.Format: 0000 000 000.
Email
example@example.com
Custody Arrangements
Are there any custody arrangements you would like us to be aware of?
If yes please explain
Parental Permission to take Photographs
I hereby give permission to the Leaders to take photographs of my child while he/she participates in planned activities. I do so with the knowledge that some of these photos in future advertising of PenCC kids activities.
Communication Consent
Please select one of the following;
Parents Guardians Signature
Date

DayMonthYear
Date
Peninsula City Church is a Child safe Church. We only collect information where it is necessary to do so to provide a service to you, or where we are required by law to do SO. Access to personal information is restricted to support staff. We will not pass any of your personal details to any other organisation. We seek to accommodate all children who wish to participate, however, our duty of care in respect to supervision ratios may mean that we are not able to provide adequate support for your child if they require constant attention by a leader to participate in kids' church.
Should be Empty:

Child Registration Form 2026