Youth Group Registration 2024 • St James Anglican Church Kununurra

Youth Group Registration Form

Hi there,

A parent or guardian needs to complete this form.

Thank you for filling out this form so that we are better able to care for your child and conform with Duty of Care regulations. Health information and some family details can be sensitive and will be kept confidential.

Please complete one form for each child being registered.

Please contact Kim or Henry if you have any questions.

In Christ,

Henry and Kim

Child's Details

First Name *

Last Name *

Gender

Date of Birth

School Grade

Health & Dietary Requirements

Allergies/Intolerances

Tip: You only need to write something here if your child has any allergies or intolerances.

Other Important details

Photography/ Video Permission Youth Group

I give permission for photos of my child to be used to advertise Youth Group within church.

I give permission for photos of my child to be used to advertise Youth Group to be used on church website/ Facebook.

Are there any access restrictions to your child (if yes, then Henry will contact you to find out details) *

Parent / Guardian Details

Parent / Guardian Full Name *

Mobile Number *

Email Address *

Mailing Address

Tip: Your PO Box is all that is required in this section

Emergency Contact

Emergency Contact Name *

Tip: Parent/s or caregiver will be contacted first.

Emergency Contacts Number *

Tip: Parent/s or caregiver will be contacted first.

Permission to participate

Indicating yes on the drop down menu below indicates:

My willingness to permit my child to participate fully in the activities of St James Anglican Church Youth Group on Friday evenings (and any other irregular days throughout the year).

Selecting Yes below certifies acceptance of the above.

Permission Given *

Date Registration Form Completed

Do you have anything else you want to add about your child so that the team can best care for your child?

Thank you for filling in the form.

The Youth Group Team will treat all the information contained confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. Please don’t hesitate to contact Henry (Assistant Minister) with any questions.