Youth Annual Permission 2021 (Narrandera/Coolamon) • CRC Countrylife

2021 CRC Youth Activities - Annual Permission

It will be great to have your child/young person join in the activites we have planned. In order for us to provide the best level of care while your child is under our supervision, we require that you fill out this registration form. Each of your children who attend youth activities can be added to this form by clicking the "add person" button below.

Child's Details

First Name *

Last Name *

Home Address *

Home City *

School Grade

Phone Number

Tip: This could be a parent/carer number or the young person's.

Date of Birth

Email Address

Please indicate whether you grant permission for a photo/image/video that includes this child/young person to be placed in church publications, on our church website or our church social media platforms.

Consent to Photograph *

Yes

Medical Information

Tip: Eg. Diabetes, asthma, allergy, ADHD, mental health conditions, disability.

Medicare Number

Number on Card

Tip: What number is the child/young person on the medicare card?

Medicare Expiry

Dietary requirements

Emergency Contacts *

Tip: Who can we contact in case of emergency? Name + Phone Number

Parent/Carer Consent

Your agreement with us

I understand that some CRC Youth activities may involve my child leaving the church premises to participate in scheduled activities. This may involve walking or transport by car or bus. I give permission for this to occur and understand that although the leaders will take all reasonable care to ensure both the comfort and safety of my child, there is still a risk that an accident may occur. In the case of an ambulance being required for my child, I authorise the leaders to arrange for this and agree to pay any costs associated with ambulance transport or medical treatment.

Parent Consent *

Yes

Name of Parent/Carer *

Tip: Who is giving permission?

Date Consent Given *