Highway Kids Enrolment Form (Ormeau) • Highway Church

HIGHWAY KIDS ENROLMENT FORM

AGE 1 - GRADE 6

Welcome to the Highway Kids online enrolment form.

This information is private and only for use of our trained leaders who are responsible for the children of "Highway Kids".

Please do not leave any field blank.

CHILD DETAILS

First Name *

Tip: One child per enrolment submission

Last Name *

Date of Birth *

Mailing Address *

Mailing City *

Mailing State *

Mailing Postcode *

Locations *

Highway Church ORMEAU

Highway Church GILSTON

Highway Church ONLINE

PARENT/GUARDIAN INFORMATION

Parent/Guardian 1 - Name *

Parent/Guardian 1 - Mobile *

Parent/Guardian 1 - Email *

CHILD MEDICAL INFORMATION

Does your child have any medical conditions and needs? *

Yes

If yes, please provide all details of any medical condition.

Does your child have any allergies or sensitivity? *

Yes

If yes, please provide ALL details:

Has your child been diagnosed at risk of anaphylaxis? *

Yes

If yes, please provide all details:

Does your child have any special dietary requirements? *

Yes

If yes, please list the requirements:

EMERGENCY CONTACT INFORMATION

In the unlikely event that the child has an accident, injury or illness and the parent/guardian cannot be contacted, Highway Kids should notify the following person, who is authorised to collect and care (including consent to medical treatment and permitting the administration of medication) for the child, after the accident, injury or illness.

Emergency Contact Full Name *

Emergency Contact Mobile *

Relationship (to the child) *

PARENT / GUARDIAN DECLARATION

Medical Treatment Consent:I being the parent/guardian of the said child/ren understand that whilst every precaution will be taken to ensure the good welfare and protection of my child/ren, Highway Church, its staff and volunteers acting on behalf are hereby released from any liability in the event of any accident or misfortune, damage or loss that may occur to my child/ren or property. In the case of emergency, I hereby give permission to the First Aid staff to ensure proper treatment for my child/ren. I have given details above of any health information about my child/ren that the First Aid staff needs to know.

Involvement consent:I being the parent/guardian of the said child/ren give my consent that my son/daughter may participate in any activities they choose whilst in Highway Kids care, whether its games, sports, etc.

Photography & Video consent:I being the parent/guardian of the said child/ren hereby give my consent for my son/daughter to be captured in both video and photographs at Highway Church. Highway Church reserves the right to use this material for promotional purposes.

Do you agree with the above declaration? *

Yes

Do you give Photo Consent? *

Yes

Enrolment Submission Date *