Kununurra Kids Club Registration 2024 • St James Anglican Church Kununurra

Kununurra Kids Club Registration Form

Kununurra Kids Club is for children from year 2 - year 6. For children to make friends, play together, develop character and learn more about Jesus and his message from the Bible.

Thank you for taking the time to complete this form so that we can better care for your child(ren). All information will be kept in accordance with our Diocese’s privacy policy. If you have any questions please ask Henry or one of the Kununurra Kids Club Team.

Child Details

First Name *

Last Name *

Gender

Date of Birth *

School

EKC

St. Josephs

Homeschooled

Other

School Grade *

Contact Details

Home Address *

Parent / Guardian Name #1 *

Mobile Number #1 *

Parent / Guardian Name #2

Mobile Number #2

Email Address

Emergency Contact Information (in case parents cannot be reached)

Emergency Contact Name *

Emergency Contacts Number *

Relationship to Child

Dietary Requirements & Allergies

Please list any known allergies (leave blank if n/a)

Dietary Intolerances (leave blank if n/a)

Other Medical Information/ Conditions/ Restrictions etc. (leave blank if n/a)

Please provide any relevant treatment plans.

I am happy to help serve and clean up afternoon tea once per term

Yes

Not at the moment

Pick Up / Drop Off

Parents/Guardians are responsible for dropping off and picking up their child. If you would like to restrict who can pick up your child(ren), please list the names of those who can sign your child in or out.

Write Names Here

Walking to Kununurra Kids Club from school & walking home

St. James Anglican Church building is in close walking distance to EKC. If you would like your child to walk with a Kids Club leader from EKC, tick the box below. We will be in contact to let you know who the leader is, and where they will meet. You will be responsible to let the leader know if your child will not be attending the program on any given week.

I give permission for my child(ren) to walk to Kununurra Kids Club each Wednesday and I will contact Henry or one the Kids Club team to inform them when my child(ren) won't be attending.

Yes

I give permission for my child to walk home after Kids Club. I understand that Kids Club leaders are no longer responsible for my child once they leave the church property.

Yes

Photography at Kununurra Kids Club

I give permission for my child to be in photographs and videos within the Kununurra Kids Club program (some activities may use this technology)

I give permission for photos of my child to be used on advertising for Kununurra Kids Club

My submission of this form indicates

My willingness to permit my child to participate fully in Kununurra Kids Club regular weekly activities.
That I give my permission, in the case of a medical emergency, for Kununurra Kids club leaders to secure proper treatment for my child, which may involve calling an ambulance.

Today's Date *

Permission Given *

Thank you for filling in the form.