Child Information
First Name
Last Name
Date of Birth
Mailing Address
Email Address
Preferred Name
Gender
Male
Female
Mobile Number
Phone Number
Emergency & Medical Information
Emergency Contact - Name & Number
Allergies
Medications/Conditions
Consent
I authorise the Leader in charge to consent, where it is impractical to communicate with me, to the Child receiving such medical or surgical attention as deemed necessary.
Yes
No
I give consent for my child's photo to be taken by a leader used for Church Program purposes only. (I.E. Brochure, website)
Yes
No
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