New Life Kids Registration
Child's details
Registration Year
*
Tip: e.g. 2021
Privacy Permissions
I give permission for my contact details to be stored electronically in the New Life database
First Name
Last Name
Date of Birth
School Grade
-- None --
Pre-school
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Gender
Male
Female
Address
Suburb
State
Postcode
Custody
Custody Order?
*
Yes
No
Custody Order Details
Medical Details
Does your child have any of the following? Please specify.
Allergies
Yes
No
Allergy details
Dietary requirements:
Asthma
Yes
No
Details of any self-administered medications to be taken:
Medicare Number:
Other relevant medical information:
Emergency Contact Details
Doctor's name:
Phone number:
Emergency contact name:
Relationship to child of emergency contact
Phone number:
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.
*
Yes
No
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.
*
Yes
No
Form completed by:
Parent/carer's name:
*
Phone Number
Date:
*
Parent Mobile Number
*
Parent Email Address
*
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