Children and Youth Program Enrolment Form 2024 • Emu Plains Anglican Church Online Community

This is the form to fill in to enrol a child into Emu Plains Anglican Church children's/youth programs. Items with an asterisk '*' must be completed.

If you have more than one child, select 'Add Another Person' at the bottom of the form and common information will be auto-filled

Child's Basic Details

Child's First Name *

Child's Last Name *

Current School Year or Stage *

Gender *

Date of Birth *

School or Care Program Attending

Children's/Youth Programs Child Attends (tick all that apply) *

Jump & Jive Playgroup (Wednesdays, under school age)

Kids Church (Sundays, 3yrs - Yr 5)

Student Chips & Chat (Sundays, Yr 6-8)

Student GG (Sundays, Yr 9-12)

House (Friday Night, Yr 6-12)

Parent/Guardian/Family Details

Parent/Guardian Name *

Parent/Guardian Mobile Number *

Parent/Guardian Email Address

Parent/Guardian Contact Phone Number

Other Parent/Guardian Name

Other Parent/Guardian Contact Phone Number

Other Parent/Guardian Email Address

Street Address *

Suburb *

State *

Post Code *

Other Information

Emergency Contact Person (other than parents/guardians) *

Tip: Please provide someone other than a parents / guardians already listed above, in case they cannot be contacted

Emergency Contact Phone *

Relationship to Child

Is there anyone legally restricted from seeing the child? *

Yes

N/A

Tip: Please indicate Yes or No.

If so, who?

My Child Has Allergies *

Yes

Tip: Please indicate Yes or No.

Describe in full any allergies (food, environment, etc.)

My child has additional needs (if so, please give details in the field to the right) *

Yes

N/A

Tip: Please indicate Yes or No.

Is there anything else that would be helpful for us to know?

Permission and Consent

I give permission for Emu Plains Anglican Church to photograph and video my child for use in promotional communications by Emu Plains Anglican Church. *

Yes

Emu Plains Anglican Church | Privacy Policy

I give permission for my child to participate fully in the children or youth programs of Emu Plains Anglican Church for which this form enrols them: *

Yes

In the case of medical emergency, I give permission to the leader and/or other persons supervising the children or youth program to secure necessary medical treatment and/or hospitalisation, injection, anaesthetic or surgery for my child as named: *

Yes

I understand that I or my child may receive information about other church activities: *

Yes

Submission Details

By entering my name and today's date below, I confirm that the details provided in this form are accurate:

Your Name *

Today's Date *