New Life Kids Registration
Tip: e.g. 2018
I give permission for my contact details to be stored electronically in the New Life database
Date of Birth
-- None --
Custody Order Details
Does your child have any of the following? Please specify.
Details of any self-administered medications to be taken:
Other relevant medical information:
Emergency Contact Details
Emergency contact name:
Relationship to child of emergency contact
Authority to Collect/Travel Home
I give permission for my child to make their own way home.
I give permission for the following person other than myself to pick up my child from this programme:
Name of person authorised to collect:
Relationship to child
Authorised Person's Phone number:
Authority & consents
Photo/Video: I consent to my child's photo or video being taken in which my child appears for use within the programme and church in general.
Authority for Contact
Contact by leader
Contact by church
Authority to administer paracetamol: I authorise the leaders of this programme to administer one dose of paracetamol to my child, as per instructions on the medication. I understand that this authority is a guideline for administration of a specific dose. I understand that I will be contacted for my permission for each specific instance. I understand the potential risks and side affects of this medication for my child.
Form completed by:
Parent Mobile Number
Parent Email Address
Add Another Person