2024 Kids Club Registration Form

KIDS CLUB REGISTRATION FORM

Do you attend a Sunday Service at Caboolture Baptist? *

Student Information

First Name *

Last Name *

Gender *

Date of Birth *

School

School Grade *

Student Contact Details

Other than general information, it is our ChildSafe policy to always attempt to contact legal parents, guardians and/or carers first, to get their permission to contact students directly.

Student Mobile Number

Student Email Address

Tip: Email addresses are extremely helpful to know also!

Home Address *

Home City *

Home Postcode *

Safety and Care Details

Parent & Emergency Contact Information

In case of an emergency, please list the phone numbers where you and a freind or relative may be contacted during the course of the program.

PARENT First Name & Last Name *

PARENT Phone Number *

PARENT Email

Tip: Email addresses are extremely helpful to know also!

EMERGENCY CONTACT First Name & Last Name *

Tip: Please list someone other than the parent listed above who we might contact (if necessary) in an emergency.

EMERGENCY CONTACT Phone Number *

EMERGENCY CONTACT Relationshsip *

Medical Information

Are there any allergies, dietary requirements, or medical conditions *

Allergies

Dietary Requirements

Medical Conditions

N/A

Allergy, Dietary & Medical Requirement Details *

Please note that in regards to non-prescription medications such as paracetemol (e.g. Panadol), it is our policy that team members and leaders do not provide medications.

Consent

Who will collect your child at the end of the program? Please nominate all adults you trust to collect your child at the end of the program:

Consent to Collect *

Do you give consent for us to use photos of your child for promotional purposes?

Consent to publish pictures *

Yes

Do you give permission for us to contact your child about Kids Club?

Consent to contact *

Yes