St Andrews Townsville - Medical Form 2024 • St Andrews Townsville

St Andrews Townsville - Medical Form 2024

Medical Form 2024

Programs and Permissions

Which programs will your child attend at St Andrews during the year?

Program Permissions *

If you are looking to register for one of the programs that we partner in running with Willows Presbyterian Church (Explorers, Adventure Club or Pressie Youth), please fill in one of their medical forms which you can find at this LINK.

Child details

First Name *

Date of Birth *

School Grade in 2024 *

Last Name *

Gender *

Medical Details - please leave empty if none exist

Does the child have any critical medical issues we need to be aware of?

Does the child have any Allergies or Intolerances or Dietary Requirements.

Does the child need to take any medication during the program?

Does the child have any other medical/behaviour conditions we should be aware of?

Is there any other information we need to know (e.g. custody order)

Medicare Number *

If no medicare number please enter 000 and provide a reason above in the 'other information we need to know' section.

Other Details and Permissions

Photos/videos may be taken during the programs by designated team members which could be displayed in a public place (e.g. church publication, presentation, internet site, Facebook page).

Photography Approved for the Child *

Are there any specific activites you do not want the attendee to participate in?

Parent/Guardian Details

Parent/Guardian Full Name *

Parent/Guardian Mobile Number *

Email Address *

Home Address *

Home Suburb *

Home State *

Home Post Code *

Emergency contact details

First contact in emergency (Name) *

First contact in emergency (Phone number) *

Second contact in emergency (Name) *

Second contact in emergency (Phone number) *

Terms and Conditions

I give permission for the personal details given herein to be provided to appropriate leaders and/or relevant medical/emergency services as deemed necessary. I understand the details given herein will be used by leaders to contact myself and/or my child/ren and that the details will not be given to any third party, except as provided above.

By completing this form, I hereby give permission for my child/ren to attend all scheduled activities, unless we explicitly advise the leadership team otherwise. In doing so I undertake to provide the leaders with any information relevant to the wellbeing of my child/ren prior to them attending any and all scheduled activities.