Protecting your information is important to us. This information will be used to best care for the participants of our Children's & Youth Ministry programs and may be shared with leaders of programs who require such information (e.g. First Aider in Charge).

Please enter the details of the participant, not the details of the carer filling out the form. 

Please provide information on any relevant conditions which require special attention that we should be aware of, e.g. insect allergies, asthma, diabetes, heart problems, epilepsy, hearing of sight impairment, ADHD, behaviour concerns, formal counselling situations, or other. 

Please provide current medical managment plan or behavoiur managment statigies and plans that may be required duing programs 

Please also speak to the program coordinator if there are any emergency action plans that need to be followed. 

Do you consent to the appropriate use, by Wellspring Anglican, of photographs taken during the program that include your child? Use may include, inclusion in our email newsletter, placement on our website, social media, or promotional flyer. 

Please list at least two contacts (name, relationship to participant, phone number) who may be contacted during the program in the case of an emergency. 

If anyone other than those listed here will be collecting your child from the program, you will need to inform the leaders of the program. This can be done using the box below (please include name, relationship to participant, phone number) or at a later date if the need arises. 

In attending the program, you consent to your child's participation in a range or general sporting, craft, and recreational activites. 

Email is often used to communicate relevant details of each program to parents/carers. Please provide your preferred email(s) below. 

I am aware, in signing (submitting) this form regarding my child's participation in programs with Wellspring, that certain elements of the program could be physically and emotionally demanding. Furthermore, I understand that certain inherent risks and dangers may exist in the activites in which my child will be particpating. I acknowledge that while the organisation and its leaders will make every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of the organisation, its leaders and staff. In the event of any emergency where my nominated contact people are unavilable: 

1. I authorise the leaders to obtain medical advice and/or assistance which they deem necessary.

2. I further authorise qualified practitioners to administer anaesthetic if required. 

3. I accept all operation, blood transfusions and/or anaesthetic risks involved in the event that such procedures are deemed necessary.

4. I accept the responsiblity for payment and agree to pay medical, transport and any other related expenses. 

5. I confirm that the information contained in this applicaion is true and correct.

6. I agree to inform the leader of any change to these details.