Children and Youth Registration 2023 • Burnie Anglican Church

Parent / Caregiver 1

This information will automatically fill for additional children below.

First Name *

Last Name *

Email Address *

Phone Number *

Home Address

Parent / Caregiver 2

This information will automatically fill for additional children below.

First name

Last name

Email address

Phone number

Home address

Emergency Contact

This information will automatically fill for additional children below.

Name *

Relationship to child *

Mobile Number *

Privacy Declaration

Burnie Anglican Church is exempt from the Requirements of the Privacy Act 1988 (Cth) as it is a "small business". However, we take the handling of personal details seriously. We seek to deal carefully with the personal information we collect and to do so in a manner consistent with your reasonable expectations.
The personal information in this form will be made available to:

the Team Leaders involved in the running of the activities in which my child participates, and
medical and emergency services if considered necessary.

Images and Video (General)

I agree that I will only take images or videos of my children, and will not publish any images or videos that contain other children without the express permission of their parents/ care givers.

Parent/ care giver consent *

Yes, I agree.

Authorisations and Expectations

I give permission for my child to attend all scheduled activities, unless I advise the Team Leader otherwise.

I authorise the Kids or Youth 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 acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my child being sent home and being temporarily or permanently prohibited from attending the activities of Burnie Anglican Church.

I will provide the Team Leader with any information relevant to the wellbeing of my child prior to him or her attending an activity. This might include supporting documentation (eg AVO, Family Court Order) if there is anyone who is legally restricted from seeing your child.

I confirm that the information given in this form is true and correct, and will advise the Team Leader of any changes to this information.

Parent/ Carer Authority *

Yes, I agree to, and authorise the above.

Child

We will keep these details on file so that we do not have to ask for them prior to each event, unless you request otherwise. Please advise the Team Leader or Church staff as soon as practical of any changes to this information.

Programs Attending

Select programs child is attending *

Playtime

Mini Makers kids club

Kids Learning Time (Sunday mornings)

Youth Group

First name *

Last name *

Gender *

Date of Birth *

School

School Grade

Home Address

Home Postcode

Medicare Details

Medicare Number *

Number on Card *

Expiry Date *

Authorisations

In addition to the people (parents/ caregivers and emergency contact) listed above, I authorise the following people to sign in and sign out my child from any kids' ministry program at Burnie Anglican Church.

Authorised people to collect children *

Comments on Transport:

Medical and Care Needs

Please indicate any medical conditions that Team Leaders should know about.

Medical Conditions

Prescription Medication

Chronic Illness

Other

Do you give permission for your child to take paracetemol if required?

Administration of Paracetamol *

Yes

Please indicate any special needs or specific care needs that we should know about to provide the best duty of care for your child.

Please also provide any helpful strategies that work with your child.

Other Special Care needs

Dietary and Allergies

Does your child have any special dietary requirements or allergies that we should know about?

Helpful Details about Allergies, including how to respond

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

Restricted persons *

Swimming

Can your child swim 30m unassisted?

Able to Swim 30m?

For Youth only

Optional, for leaders to use to contact.

Email address

Mobile

Do you authorise your child to make their own way to and from Youth Group?

Consent for youth group

Yes, my child can make their own way to or from Youth Group

No, my child will be dropped off and collected by an adult.

Images and Video

I agree that I will only take images or videos of my children, and will not publish any images or videos that contain other children without the express permission of their parents/ care givers.

As a church that seeks to reach out to the community and offer glimpses of parish life, we occasionally require images of people to publish on church media. In our particular church context, this might include (but not be limited to): website, brochures, social media, signage etc. We would love for you to be willing to be part of our media, but we understand that sometimes this is not preferable for many people. We want to invite you to allow the church create and use your image for the above purposes. You can allow this by filling out this section of the form for your family. It allows you to indicate some or all of your family members with whom images are able to the used. We ask that both parents sign where this is possible (even if one or both parents are preferring their photos not to be used).

Will you get to check the photo before publication? Yes. If a photo that contains your image is chosen to be published, we will check with the people in that image to make sure they are okay with the particular image being published.

What am I permitting exactly?

We require two sets of permission:
1) Permission for the ‘creation’ of an image (including video)(i.e. the taking of a

photograph and the storage of the photograph on a hard drive)
2) Permission for the ‘use’ of an image (i.e. the publishing, or projection of an image).

You can also indicate that you wish to limit your photo publication to the parish directory only.

Parent/ care giver consent to creation of images *

Yes, I agree to the creation and storing of images or videos.

No, I do not agree to the creation and storing of images or videos.

Parent/ care giver consent to publication of images *

Yes, I agree to the publication of images and videos.

No, I do not agree to the publication of images and videos.

Parent/ Care Giver 2 gives consent (where applicable)

Parent/ Care Giver 2 gives consent to creation and storing of images

Parent/ Care Giver 2 gives consent to publication of images

Yes, parent/ care giver 2 gives consent to publication of images.

Burnie Anglican Children and Youth Registration 2023

Parent / Caregiver 1

Parent / Caregiver 2

Emergency Contact

Privacy Declaration

Images and Video (General)

Authorisations and Expectations

Child

Programs Attending

Medicare Details

Authorisations

In addition to the people (parents/ caregivers and emergency contact) listed above, I authorise the following people to sign in and sign out my child from any kids' ministry program at Burnie Anglican Church.

Medical and Care Needs

Dietary and Allergies

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

Swimming

For Youth only

Images and Video