Youth Registration Form

PARENT / GUARDIAN INFORMATION
Parent / Guardian Full Name *
Parent / Guardian Full Name
Parent/ Guardian Mobile Phone Number *
Parent/ Guardian Mobile Phone Number
Address *
Address
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
CHILDS INFORMATION
Students Name *
Students Name
Students Date of Birth *
Students Date of Birth
Child Contact Number *
Child Contact Number
Consent *
As the parent/ guardian of the above child/ children I agree to the following conditions: I understand that whilst every precaution will be taken to ensure the well being and protection of the attendee, Public Church and its staff and leaders are hereby released from any liability in the event of an accident to my child/ children. I hereby give permission for the first aid officer to administer paracetamol to my child/ children if deemed necessary by the first aid officer. I hereby give permission for my child/ children to participate in activities they choose to over the course of the camp. I hereby give permission for the my child/ children to be captured in both photographs and videos at Public Youth + Youth Alive Presents "Wild Ones - Summer Camp 2018" I understand that Public Church is committed to protecting the privacy of my personal information. All information collected enables Public Church to provide me with the services I have requested and is managed in accordance with the Privacy Act 1988.

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