Kids Church – General Info and Consent Form

Child's Details

Child’s Full Name

Date of Birth

School Year (if applicable)

Home Address

Contact Name, Numbers and Relationship to Child

First Contact

Name
Relationship
Mobile phone
Home phone

Second Contact

Name
Relationship
Mobile phone
Home phone

Additional Information

Details of any medical information including allergies.

Details of any other important information.

Unfortunately, we are unable to take children to the toilet or change nappies. Please indicate here if your child is able to take themselves to the toilet or you need us to come and get you/they are in nappies.

Child can take themselvesChild in nappies/needs assistance

Photograph and Image Consent

From time to time, we like to take photos to be used on the website, or as part of a service (e.g. a photo on the screen). Please select Yes or No as to whether you consent to us using an identifiable image of your child/ren.

Church Website
YesNo

Social Media (Facebook, Instagram, Twitter)
YesNo

The Sunday morning livestream to YouTube and our church website
YesNo

I consent to the above information being shared with Kids Church volunteers.
YesNo

Your name
Your email address
Date completed

Δ