Kids Rego | Port Kembla and Warrawong Churches

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YOUTH AND Kids rego

This form registers you for Port Church Kids, Port Kids Club and Port Youth each week.

Name/s of children*

Weekly Registration

This form registers you for Port Church Kids, Port Kids Club and Port Youth for 2024.

Children's details

First name

Last name

Gender

Date of Birth

School Grade 2024

Name of School

Which program(s) are you registering for: (check all that apply) * Required

Kids Church

Port Kids Club

Port Youth

I consent to photos and/or videos of this child to be taken and used for promotion of Port and Warrawong Churches Kids * Required

Yes

Medical and Care Needs

Does this child have any allergies? * Required

Yes

Does this child have any medical, behavioural or care needs? * Required

Yes

eg. physcial difficulties, asthma, chronic illness, learning difficultues or mental disabilities etc.

Is there anyone who is legally restricted from seeing your child?

Yes

Parent/Guardian Details

Parent/Guardian 1

First name

Last name

Mobile Number

Email Address

Parent/Guardian 2 (optional)

First name

Last name

Mobile Number

Email Address

Home Address

Address

Suburb/Town

Postcode

Authorisation & Expectations

I give permission for my child to attend all scheduled Kids activities, unless I tell leaders otherwise.
I understand that the personal details given in this form may be given to kids leaders who care for your child and that the details will not be given to any third party except for relevant supervisory/medical or emergency services personnel as deemed necessary.
I authorise the Kids leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue, or other services that are considered necessary for my child.
I understand that unacceptable behaviour may result in my child being sent home and/or being temporarily or permanently prohibited from attending the activities.
I declare by ticking the box below that I am a parent or legal guardian of the child/ren detailed in this form, that the information given above is true and correct and that I agree to the terms provided.

Full Name

I consent

Thanks for registering your child. Return to top to register another child. We look forward to meeting you :)

PorT + Warrawong churcHES

LOCATIONS

Port Kembla Anglican

111 Military Road

Port Kembla, 2505

Warrawong Anglican

282 Cowper Street
Warrawong, 2502

Phone: 4274 6953
office@pkw.org.au

give

Account Name: Port Kembla Anglican Parish Council

BSB: 032-694

ACC: 114040

Thank you for your generosity!

YOUTH AND Kids rego

Authorisation & Expectations

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