Youth Enduring Permission Form • St Matts West Pennant Hills

Hi!

Thanks so much for registering your child to attend youth at St Matt's West Pennant Hills. We are so glad you're child is joining us on Friday nights! Please feel free to contact John Batten (Youth Minister) at jbatten@stmatts.org.au or on 0409 986 915 should you have any questions or concerns.

Youth Programs

Please indicate which group/s your child attends *

Youth Fridays

Sunday 9:30 Youth

Child's Details

First Name *

Preferred Name

Last Name *

Date of Birth *

Gender *

School

School Grade *

Home Address *

Home City *

Home State *

Home Postcode *

Mobile Number

Email Address

Important information about your child

Are there any of the following we should know about? Allergies / medication / special diet / activity restrictions / behavioural issues *

Details of allergies / medication / special diet / activity restrictions / behavioural issues *

Is there any other medical info?

Yes

Details of other medical info

Is there anyone restricted from seeing your child?

Yes

Details of prohibited person

Photo information

Photos will be taken on occasion at our St Matts youth activities.
Do you give consent for photos to be take of your child?

Picture Permission *

Yes

Tip: These photos will be used on our social media for recap videos shared with youth.

Photos may be used for advertising purposes. *

I consent to photos of my child being used in church activities

I DO NOT consent for photos of my child to be used to promote St Matts youth activities

Parent/Carer/Emergency Contact Details

#1

EC Name #1 *

EC Number #1 *

#1 Relationship to Child *

Email *

Address (if different from above)

#2

EC Name #2

EC Number #2

#2 Relationship to Child

Emergency Contact Information

Not the Parent/Guardian listed above

Emergency Contact Name

Emergency Contact Mobile

Any additional information that will be helpful for us to care for your child

Permission

PARENTS PLEASE READ, SIGN AND DATE THE FOLLOWING:

My signature below indicates my willingness to permit my child:
to participate fully in youth programs within the parish church of St Matthews Anglican Church, West Pennant Hills.
in the case of a medical emergency, I hereby give permission to the Doctor chosen by the church authorities or other persons supervising or administering the childrens activity, to secure proper treatment for and/or order hospitalisation, injection, anaesthetic, or surgery for my child as named. I understand that every effort will be made to contact me prior to instituting such procedures.

PARENT OR GUARDIANS NAME BELOW CERTIFIES ACCEPTANCE OF ALL THESE CONDITIONS

Parent/Guardian Name *

Today's Date *

Tip: Date of consent

The leadership team of the aforementioned group will treat the information contained confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. If you wish to access this information or have any queries in relation to the manner in which we handle your personal information, please do not hesitate to contact us.