Children's & Youth Ministry Enrolment Form • Wellspring Anglican Church

Parent/Guardian Details

Parent/Guardian 1

First Name *

Last Name *

Address *

City *

Postcode *

Mobile number *

Alternative phone number

Email Address *

Parent/Guardian 2

First Name *

Last Name *

Home Address

as above

Home Address 2 (optional)

City

Postcode

Email address *

Mobile number *

Alternate phone

Additional Emergency Contacts

Contact Name & Phone Number

Child's Details

First Name *

Last Name *

Preferred Name

Date of Birth *

School Grade *

Gender *

Medical Information

For us to best meet the needs of this child while in our care, please advise us of the following information:

Please describe (in particular include details of medication that needs to be administered during the program)

Permissions

I am aware that certain elements of the Children's & Youth ministry programs could be physically and emotionally demanding. Furthermore, I understand that certain inherent risks and dangers may exist in the activities in which my child will be participating. 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 an emergency, I understand that parents/guardians will be contacted immediately and if they are unavailable, emergency contacts will be contacted. Basic first aid will be administered as needed and emergency medical care will be sought if needed, under the direction of parents/guardians or emergency contacts.

With the above in mind, I give permission for my child to participate in Wellspring's Children & Youth Ministry Program and I also give the following (8) permissions, as indicated. Please scroll below so you can check all 8 permissions before submission. *

I have filled out the above form and answered questions honestly to the best of my knowledge.

I have carefully read & understood the above information and give permission for my child to participate in this program.

I give permission for my child to receive basic first aid for any minor bumps or bruises.

I give permission for videos/photos containing my child to be used for promotional purposes for Anglican children's ministry.

I give permission for videos/photos of my child to be posted on closed private website for Wellspring parents.

I understand that this is a Christian program with Biblical Christian teaching content. I give permission for my child to attend.

I give permission for my child to receive occasional treats/special foods in keeping with any allergies/intolerances outlined above.

By pressing 'SUBMIT' below, I agree to the above conditions, as indicated.