Crosslight Children and Youth Registration • CROSSLIGHT

Children & Youth Ministries Registration Form

All information below is required for Safe Ministry purposes. For further information on our Safe Ministry practices at Crosslight, click here.

Information is kept confidential within the ministry team, but may be required to be shared with emergency services.

Group Attending ( select as many as relevant) *

Child / Youth Participant

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

Home Address *

Home City *

Home Postcode *

Is there anyone who is legally restricted from seeing this child? *

Name of restricted person. *

Does this child have any allergies? *

Please specify allergy details and in the case of anaphylaxis and/or asthma provide a management plan. *

Does this child have any special dietary requirements? *

Please specify dietary requirements. *

Does this child have a medical condition, disability, behavioural issue, special needs or require medication that the leadership team need to be aware of? *

Please provide all details of conditions, requirements, activity restrictions, medications, management plan. *

Can this child swim at least 30 metres unassisted? *

Yes

PARENT / GUARDIAN DETAILS

Relationship to Child *

First Name *

Last Name *

Mobile Number *

Email Address *

Address *

Suburb, Postcode *

EMERGENCY CONTACT DETAILS (SEPARATE FROM PRIMARY CARER DETAILS)

First Name *

Last Name *

Mobile Number *

Relationship to Child *

ADDITIONAL PERMISSION

Who else is permitted to collect your child? *

TERMS & CONDITIONS

Name of person submitting the form *

In submitting this form, I hereby give permission for:

This child to participate in the relevant ministry activity of the parish
In the case of a medical emergency, for the ministry leaders to obtain, at my expense, any medical, ambulance, rescue, or other services considered necessary for this child
This child to be photographed or videoed during ministry activities and for those images to be displayed publicly online or in print unless I advise leaders otherwise