Kid's and Youth Ministry Under 18 Permissions and Medical Form 2025

Parent/Guardian Details

Parent/Guardian Full Name *

Parent/Guardian Mobile Number *

Phone Number

Home Address *

Home Suburb *

Home State *

Home Post Code *

Email Address *

Emergency contact details

First contact in emergency (Name) *

First contact in emergency (Phone number) *

Relationship to child *

Second contact in emergency (Name) *

Second contact in emergency (Phone number) *

Relationship to child *

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 the medical forms which you can find at this LINK.

Child details

Child First Name *

Child Last Name *

Sex *

Child Mail Residential Address (Only provide if different to Parent/Guardian Information)

Date of Birth *

School Grade in 2025

School

Medicare Number *

Position on Card *

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

Does your child have any medical, dietary or care issues that the Ministry Coordinator should know about? *

Yes

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

Yes

If Yes, to either of the above, please proivide details:

For alergies please indicate severity i.e. mild, moderate, severe or anaphylactic, what triggers the reaction (inhalation, physical contact, ingestion) and how the reaction presents in your child.

Critical issues

Allergies & Intolerances

Other health/behaviour issues

Further Details:

Is your child subject to a custody order? *

If Yes, please provide details to the Ministry Coordinator or Minister.

Is there anything else we need to know

Other Details and Permissions

I would like my child to recieve reminders about upcoming events via SMS and/or Email *

Yes

If Yes please provide information for your child:

Child Mobile

Child Email

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 *

Transport Approved for the Child

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

Terms and Conditions

PRIVACY DECLARATION

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.

AUTHORISATIONS & EXPECTATIONS

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.

I understand that every effort will be made to provide a safe environment, however in signing this form I authorise the leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue or other services considered necessary.

I also acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my child/ren being sent home &/or being temporarily or permanently prohibited from attending the activities of this group.