Minis Playtime Registration form • St Matts West Pennant Hills

Which day(s) are you attending? *

Tuesday

Wednesday

Thursday

Parent/Carer Details

First Name *

Last Name *

Relationship to Child *

Mobile Number *

Email Address *

Children attending Minis Playtime (include surname if different from parent/carer)

#1 Child's name *

#1 Child's birthday *

#1 Does this child have any allergies?

.......

#3 Child's name

#3 Child's birthday

#3 Does this child have any allergies?

#2 Child's name

#2 Child's birthday

#2 Does this child have any allergies?

Home Address *

Home City *

Home State

Home Postcode

Picture permission

Do you grant permission for images of your child to be taken at minis playtime to be used in future promotional material for St Matthew’s Anglican Church children activities, including but not limited to photos and videos in the form of printed media, promotional videos, and images which may appear on the St Matthew’s website?

Picture Permission

Yes

Publication Permission

Yes

Do you give permission for your name (and child's name), email and contact number to go on a parents contact list? This makes it easier to swap rostered duties if required

Yes

Payment details

You can pay registration by the term $40 or pay for the year $130 ('early bird' rate)

You can pay by:

Direct deposit to account:

St Matthews Anglican Church

BSB:012 306

Account No.: 108 494 487

(include M4M and your name in the details, and please notify the day leader or office@stmatts.org.au.)

Or in person:

Cash or EFTPOS at the office

Please sign and date

Please note that St Matthew's Anglican Church does not take responsibility for your children while at Minis Playtime. You are responsible for looking after your children and if your children are present without you, you will need to leave them in the care of another adult.

Important immunisation note: If your children have not been immunised and there is an outbreak of an infectious disease in the community it is recommended that you do not attend Minis Playtime for the duration of the outbreak.

The leadership team or the aforementioned group and the staff of St Matthew's Anglican Church will treat the information contained in this form confidentially. 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, Church office 9479 3700.

I have read the information letter including the discipline and health policy *

Yes

Name: *

Date signed *