Ahoy Mateys!! Kids Holiday Club • Wild Street

Child (1 Day) 0

AHOY MATEYS!! Kids Holiday Program Registration

In accordance with the Privacy Act, 1988, we inform you that all personal information collected will be used for the purpose of contacting carers in the event of an accident/emergency, supplying appropriate medical care for your child if the need arises and for informing you of future children's activities that are authorised or approved by Wild Street Anglican Church. It will not be distributed to any other organisation. Thank you for providing this important information. The safety and well being of the children is our primary concern.

Attending Child's Information

First Name *

Last Name *

Date of Birth *

Gender *

School Grade *

Which days will your child be attending? *

Monday 15th April

Tuesday 16th April

Wednesday 17th April

Does your child have an allergy/medical condition that we should be aware of? *

Yes

No

Allergies/Medical Conditions

Parent/Guardian Details

Parent/Guardian Name *

Parent/Guardian Surname *

Email Address *

Mobile Number

Emergency Contact Information

In the event of an emergency, leaders will contact the parents of the child/ren involved first. Should the leaders be unable to reach the parents, please provide another person who can be contacted in the event of an emergency regarding your child.

Emergency Contact Name *

Emergency Phone Number

Relationship to Child

In case of an emergency requiring immediate treatment, authority is given for the leaders to provide appropriate First Aid treatment.

Authority to provide medical treatment *

Yes

No

Permissions

I give permission for my child to participate fully in the Ahoy Mateys!! Kids Holiday Program run by Wild Street Anglican Church, Maroubra. I understand that these activities will be run on the premises of the church, as well as Nagle Park (opposite the church).

I permit my child to participate in the above activities run by Wild Street Kids *

Yes

Is there any Legal restriction on who can pick up your child? *

Yes

No

If yes, please provide details.

To help capture the fun of Ahoy Mateys!!, some photographs of your children may be taken on the day. Only authorised members of the Ahoy Mateys!! team will be permitted to take photographs. These photographs will only be for use within Wild Street Church (group photos only, no names) and will not be distributed to outside sources without the express permission of the Parents/Guardians. Please indicate below if you give permission for your child to be photographed during Ahoy Mateys!!

Photo Permission *

Yes

No

Additional Information

Is there any other information that will help us care for your children? Please provide details.

How did you hear about Ahoy Mateys?

Child (2 Days) 0

AHOY MATEYS!! Kids Holiday Program Registration

In accordance with the Privacy Act, 1988, we inform you that all personal information collected will be used for the purpose of contacting carers in the event of an accident/emergency, supplying appropriate medical care for your child if the need arises and for informing you of future children's activities that are authorised or approved by Wild Street Anglican Church. It will not be distributed to any other organisation. Thank you for providing this important information. The safety and well being of the children is our primary concern.

Attending Child's Information

First Name *

Last Name *

Date of Birth *

Gender *

School Grade *

Which days will your child be attending? *

Monday 15th April

Tuesday 16th April

Wednesday 17th April

Does your child have an allergy/medical condition that we should be aware of? *

Yes

No

Allergies/Medical Conditions

Parent/Guardian Details

Parent/Guardian Name *

Parent/Guardian Surname *

Email Address *

Mobile Number

Emergency Contact Information

In the event of an emergency, leaders will contact the parents of the child/ren involved first. Should the leaders be unable to reach the parents, please provide another person who can be contacted in the event of an emergency regarding your child.

Emergency Contact Name *

Emergency Phone Number

Relationship to Child

In case of an emergency requiring immediate treatment, authority is given for the leaders to provide appropriate First Aid treatment.

Authority to provide medical treatment *

Yes

No

Permissions

I give permission for my child to participate fully in the Ahoy Mateys!! Kids Holiday Program run by Wild Street Anglican Church, Maroubra. I understand that these activities will be run on the premises of the church, as well as Nagle Park (opposite the church).

I permit my child to participate in the above activities run by Wild Street Kids *

Yes

Is there any Legal restriction on who can pick up your child? *

Yes

No

If yes, please provide details.

To help capture the fun of Ahoy Mateys!!, some photographs of your children may be taken on the day. Only authorised members of the Ahoy Mateys!! team will be permitted to take photographs. These photographs will only be for use within Wild Street Church (group photos only, no names) and will not be distributed to outside sources without the express permission of the Parents/Guardians. Please indicate below if you give permission for your child to be photographed during Ahoy Mateys!!

Photo Permission *

Yes

No

Additional Information

Is there any other information that will help us care for your children? Please provide details.

How did you hear about Ahoy Mateys?

Child (Full 3 Days) 0

AHOY MATEYS!! Kids Holiday Program Registration

In accordance with the Privacy Act, 1988, we inform you that all personal information collected will be used for the purpose of contacting carers in the event of an accident/emergency, supplying appropriate medical care for your child if the need arises and for informing you of future children's activities that are authorised or approved by Wild Street Anglican Church. It will not be distributed to any other organisation. Thank you for providing this important information. The safety and well being of the children is our primary concern.

Attending Child's Information

First Name *

Last Name *

Date of Birth *

Gender *

School Grade *

Which days will your child be attending? *

Monday 15th April

Tuesday 16th April

Wednesday 17th April

Does your child have an allergy/medical condition that we should be aware of? *

Yes

No

Allergies/Medical Conditions

Parent/Guardian Details

Parent/Guardian Name *

Parent/Guardian Surname *

Email Address *

Mobile Number

Emergency Contact Information

In the event of an emergency, leaders will contact the parents of the child/ren involved first. Should the leaders be unable to reach the parents, please provide another person who can be contacted in the event of an emergency regarding your child.

Emergency Contact Name *

Emergency Phone Number

Relationship to Child

In case of an emergency requiring immediate treatment, authority is given for the leaders to provide appropriate First Aid treatment.

Authority to provide medical treatment *

Yes

No

Permissions

I give permission for my child to participate fully in the Ahoy Mateys!! Kids Holiday Program run by Wild Street Anglican Church, Maroubra. I understand that these activities will be run on the premises of the church, as well as Nagle Park (opposite the church).

I permit my child to participate in the above activities run by Wild Street Kids *

Yes

Is there any Legal restriction on who can pick up your child? *

Yes

No

If yes, please provide details.

To help capture the fun of Ahoy Mateys!!, some photographs of your children may be taken on the day. Only authorised members of the Ahoy Mateys!! team will be permitted to take photographs. These photographs will only be for use within Wild Street Church (group photos only, no names) and will not be distributed to outside sources without the express permission of the Parents/Guardians. Please indicate below if you give permission for your child to be photographed during Ahoy Mateys!!

Photo Permission *

Yes

No

Additional Information

Is there any other information that will help us care for your children? Please provide details.

How did you hear about Ahoy Mateys?

Date & Time

Child (1 Day) 0

AHOY MATEYS!! Kids Holiday Program Registration

Attending Child's Information

Parent/Guardian Details

Emergency Contact Information

Permissions

Additional Information

Child (2 Days) 0

AHOY MATEYS!! Kids Holiday Program Registration

Attending Child's Information

Parent/Guardian Details

Emergency Contact Information

Permissions

Additional Information

Child (Full 3 Days) 0

AHOY MATEYS!! Kids Holiday Program Registration

Attending Child's Information

Parent/Guardian Details

Emergency Contact Information

Permissions

Additional Information