Kids & Youth Registration • St Jude's Anglican Church Carlton

At St Jude's, we love welcoming children and youth into our programmes. So that we can look after your child to the best of our ability, please take the time to fill in this registration form. The information collected will be used to help St Jude's children & youth ministry leaders to plan programmes and activities, to keep parents/guardians informed of our activities, and to act appropriately in the case of a medical emergency during participation in any of our ministries. Please complete one form for each child.

For more information on St Jude's Privacy Policy, please refer to the documents at the bottom of our website: www.stjudes.org.au

Registration Details

First Name *

Date of Birth *

School Grade

Last Name *

Gender *

Name of School

Allergies

Other Special Considerations that may affect participation in activities

If you would like to share more specific information about your child's needs, please contact our office at admin@stjudes.org.au and they will put you in touch with the appropriate team leader.

My child will attend: (check all that apply)

Parent or Guardian Contact Details

Parent or Guardian name & details

Relationship to Child *

First Name *

Last Name *

Email *

Phone Number

Mobile Number *

Spouse or Alternate Contact details

Relationship to Child

First Name

Last Name

Mobile Number

Home Address

Home City

Home State

Home Postcode

Home Country

Mail Address

Required only if different to Home Address

Mailing Address

Mailing City

Mailing State

Mailing Postcode

Mailing Country

Medical Information

Ambulance Cover

Private Health Insurance

Ambulance Membership No.

Insurance Provider & Number

Permission

I consent to my child’s participation in St Jude’s Kids and Youth programs during Sunday services, Friday Night Youth Ministry, camps, conferences, playgroups, respite care (rEcess) and such other St Jude’s events as they may attend from time to time. I will encourage my child to participate and co-operate with the leaders and other participants. I agree to collect my child promptly at the end of the program, and acknowledge that supervision of my child is my responsibility before the program commences, and after it is concluded.

I consent for my child to participate in activities offsite with due notice given.

I consent for my child to be transported in private cars arranged by the leaders of St Jude’s Anglican Church.

I authorise the leader/s in charge of any activity conducted by St Jude’s Anglican Church in Carlton to consent on my behalf, where it is impractical to communicate with me, for my child to receive medical or surgical treatment as may be deemed necessary. I am also responsible for the cost of any medical treatment deemed necessary.

I (Parent/Guardian) consent to all of the above. *

Yes

Full Name (qualifies as signature) *

Date *

I understand that from time to time photographs and/or video footage may be taken of my child during St Jude’s children’s programs and other activities. I am willing for images of my child to be so recorded in appropriate settings. I am also willing for recognisable photographs or footage of my child to be used as indicated below, in a way that does not identify their name or details. My child is also willing for this to take place. I am aware that St Jude’s will use such photographs and/or video footage in good judgment in accordance with my permission, and that I have the right to revoke this permission at any time.

Please check all of the options that apply below.

*If this option is checked, St Jude's will make every effort to ensure any photographs or video footage of your child is promptly destroyed.

I (Parent/Guardian) consent to recognisable photographs and/or video footage of my child being used in the following manner: *

displayed on public noticeboards within St Jude’s church building

for St Jude’s ‘in-house’ publicity - including printed and projected images (for example, to advertise a camp or programme)

in the context of St Jude’s children’s programmes or St Jude’s services - including printed and projected images (for example, to enhance a song, or present a drama)

in printed material for use external to St Jude’s (for example, in Welcome Packs or publicity brochures)

on the St Jude’s church website

in social media (FB & insta)

I do not wish recognisable photographs or video footage of my child to be used by St Jude’s in any context*

Full Name (qualifies as signature) *

Date *