Children’s / Youth Ministry Registration form

Children’s or Youth Ministry Registration form

This form is intended to assist leaders in case of any medical emergency during the course of participation in any children’s or youth ministry activity. Please complete fully and return as soon as possible. This form is to be filled out by the parent/guardian of the participant.

St Luke's Anglican Church, Frankston East
Children’s / Youth Ministry

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Year

Child’s Name:

Address

Date of Birth

School Year

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Parent/Guardian #1 details - (Primary contact)

Relationship to child

Address

Parent/Guardian #2 details -(Secondary contact)

Relationship to child

Address

Is there any custody arrangements in place?

Yes

If yes, please specify

Emergency Contact

Address

Relationship to Participant:

Authorised to collect child:

Yes

Doctor/ Health Contact

Doctor/ Health Phone No

Doctor/ Health Address

Medicare No:

Health Care Card No:

Medical/Hospital Fund:

Membership No:

Are you an Are you an ambulance subscriber??

Yes

Ambulance Membership No:

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Medical:

Are there any medical conditions, allergies, individual safety risks the leaders need to be aware of?

Does your child have an asthma management plan?

Yes

If yes, please specify

Does your child have an anaphylaxis management plan?

Yes

If yes, please specify

Does your child have an emergency response plan re medical/safety needs?

Yes

If yes, please specify

Does your child have a Mealtime Profile/Mealtime Management plan?

Yes

If yes, please specify

Will your child have any medication?

Yes

If yes, please specify

Who is to administer the medication?

Child

Leader

Other

Does your child have any special food requirements?

Yes

If yes, please specify

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Permissions:

yes

I consent to my child’s/youth’s participation in the activities of which I have received notification. I will encourage my child to participate and co-operate with the leaders and other participants.

yes

For ministry and care purposes, I consent to my child/youth’s participation in electronic communication means and electronic platforms that remain permissible and legal for under 16 year old children or youth (eg. texting, group texting platforms, Zoom, Whatsapp, email). St Luke's will use platforms that comply with the recent social media ban for u16s. For those 16 and over I consent to the use of appropriate social media platforms in addition to the above. I understand that St Luke's practice is to have two leaders and a parent (where parent is accessible) with visibility with respect these communications rather than one-one communication to a child/youth.

yes

I give permission for my child to be transported in private cars arranged by the leaders as necessary for the program.

yes

I give consent for photographs and video footage of my child during activities and am willing for my child to be so filmed in appropriate settings and for these photos or footage to be used to promote the ministry in a way that does not identify their name or details. My child is also willing for this to take place.

yes

I authorise the leader/s in charge of any activity conducted by this above-named church to consent on my behalf, where it is impractical to communicate with me, for my child to receive medical or surgical treatment as may be deemed necessary. I am also responsible for the cost of any medical treatment deemed necessary.

Names of people allowed to collect my child in the event that I am unable:

If a person other than the parent or authorised persons named above is to collect the child on a particular day, permission must be given in person by the parent on the day.

Signature

Date:

Recaptcha v2

St Luke's Anglican Church, Frankston East Children’s / Youth Ministry

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Medical:

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Permissions:

If a person other than the parent or authorised persons named above is to collect the child on a particular day, permission must be given in person by the parent on the day.

St Luke's Anglican Church, Frankston East
Children’s / Youth Ministry