Wild Time Registration Form

Child's Information

First Name *

Last Name *

Date of Birth *

School Grade *

Any additional information (e.g. allergies, disabilities, special diets, restrictions on pickup etc.)?

Parent/Guardian Details

Parent/Guardian Name

Email Address *

Phone Number

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 *

Tip: Someone other than a Parent/Guardian

Relationship to Child *

Emergency Phone Number *

In case of an emergency requiring immediate treatment, authority is given for the leaders to provide appropriate medical treatment or to obtain at my expense any medical, ambulance, rescue or other services that are considered necessary for my child.

Authority to provide First Aid and/or seek further medical treatment in an emergency. *

Yes

Legal Permissions

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

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

Yes

Photograph Permissions

Photos/Videos are sometimes taken during Kids Church activities. These photographs may be used for newsletter or advertising within Wild Street Church (group photos only, no names) but are not distributed to outside sources. Occasionally, images or video footage taken during kids church activities might be used in advertising that is used on the Wild Street Website. Please indicate below if/how you'd like photos of your child to be used.

I give permission for photos of my child to be used within Wild Street Kids Church *

Yes

I give permission for photos of my child to be used for advertising of Wild Street Kids Church *

Yes

I give permission for photos of my child to be used on the Wild Street Website/Social Media pages *

Yes

Additional Information

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

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.

You can view our Privacy Policy here.