Youth Group Information Form

Signature upload (Office Use Only) - start form below

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Child/Youth Name & Details

Name

Youth Email & Phone
We will only use a youth's contact details to Email or SMS weekly information about Youth Group. This will not be used for indidual email, SMS or phone calls from a Youth Leader without express parental permission.

Youth's Email (optional)

Youth Phone (optional)

Gender

Male Female

Address

School

Grade

Emergency Contacts/Family

Mother/Guardian1

Mother/Guardian 1 Phone

Mother/Guardian 1 Email

Father/Guardian2

Father/Guardian2 Phone

Father/Guardian2 Email

Medical Information & Permissions

Please give as much details as needed so we can be properly informed especially in an emergency.

Doctor

Doctor Phone

Allergies

Dietary Requirements

Medical Conditions/Needs

Medicare Number

Prescription Medications

Permission to administer paracetemol

Yes No

I authorise the use of calling an ambulance by a trained first aid person if in his/her judgment it is necessary. You will be promptly contacted if we feel this step needs to be taken

Yes No

I authorise the leader in charge of the Bairnsdale Baptist Church program my child/youth is attending to arrange for my child to receive first aid as a trained first aid person may deem necessary.

Yes No

I accept responsibility for payment of all expenses associated with such treatment.

Yes No

Swimming Ability Cannot Swim Weak Swimmer (< 50m) Fair Swimmer (50-100m) Competent Swimmer (100-200m) Strong Swimmer (>200m)

Who has permission to drop off or pick up your child (other than those stated above)?

Media Consent

Bairnsdale Baptist Church is looking to share the story of what is happening at our children and youth ministries with parents, families, the youth, Bairnsdale Baptist Church and the wider community. We are planning to do this via the church website as well as on our own Facebook and Instagram pages.

In sharing our story, we intend to use photos, video, audio and commentary about church events and activities.

We are asking your permission to use media such as photo, video, audio, and comments of your in paper publications (newsletters), our website, Facebook and Instagram.

Granting Permission

By selecting "Yes" below I give consent for Bairnsdale Baptist Church to use

Media (photo/video/audio) and comments of your child in paper publications and/or on websites including social media.

Media, written comments and/or work samples which may identify your child by first name only.

The permission will continue until I revoke permission in writing or via an email.

I give consent to the church media use for my child/youth

Yes No

To complete this form a signature is needed. Please click submit below and then click "Sign here" on the confirmation page.

Youth Group Information Form

Description

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