Ignition Youth Registration Form • Max Life Church

YOUTH DETAILS

Youth First Name *

Youth Surname *

Youth Date of Birth *

Youth School Grade

Youth Age *

If you are over 18 you will need to have a Working with Children's Check in order to continue attending. Please select *

I think I already have a valid Working with Children's Check WWCC (current for 5 years)- I will send you details asap

I have a valid Working with Children's Check WWCC- can give you number now

I would like to apply for a free WWCC through Max Life Church

WWCC Screening Unique ID

Verified

Youth Mobile Number (if applicable)

Youth Home Address *

Home City *

Youth Email Address (if applicable)

Dietary Requirements

Medical or other information we may need to know about the child ie allergies inc. Food Allergies, Medical concerns, Special Needs, Anything else we should be aware of (contact us if needed). Please forward us a copy of the Child's Health Care Plan if relevant

Tip: Please contact Tracy if you have particular concerns ph 0408622475

First and Surname of Primary Parent/Guardian *

Relationship to Youth *

Parent/Guardian's phone *

Name of Alternative Emergency Contact *

Emergency Contact's Relationship to Youth *

Emergency Contact's phone number *

By selecting yes; I indicate that my child/dependent or self (if youth) agrees to the following Code of Conduct for participation at Ignition Youth. Youth Code of Conduct: 1.Participants must be considerate towards other youth and leaders and cooperate with reasonable requests from leaders 2. Alcohol or other illegal drugs (inc. vaping and smoking) are not permitted (also no Energy Drinks). 3. Participants may not to leave the premises before the end of the program without parent permission. *

PARENT CONSENT- Please tick and sign electronically

Please select *

I am the legal PARENT/caregiver of the youth

I am a YOUTH OVER 18 years

This youth is IN MY CARE for the night (eg. parent of friend of child) OR I am a YOUTH UNDER 18

By selecting 'yes' I give permission for my child/dependent or self (if youth is over 18) to be photographed or videoed at Ignition or related activities for use in promotional media, the church website and on social media. *

Could you please provide more details so leaders understand your wishes

By selecting 'Yes' I give permission for my child/dependent or self (if over 18) to participate in Max Life Church Ignition Youth Activities. I exclude the leaders/supervisors/& the church, from any personal liability in respect to any injury, illness or loss of property that may befall myself or my child/dependent/self whilst in their care. In the event of injury or illness to my child/dependent/self, I give approval to any necessary first aid, medication, or treatment to be carried out by a leader or legally qualified medical practitioner (inc transport by ambulance and hospital treatment if needed). Should this be necessary, I agree to pay for any medical care and understand that I will be notified as soon as possible. I give consent for my child/dependent/self to be transported by bus or personal vehicle driven by fully licensed Ignition Youth Leaders or authorized volunteers if required on occasions. I authorize Ignition Leaders to contact youth directly via their phone or social media. *

Youth are unable to attend without consent. Please contact us if you would like to discuss your concerns

We will need the youth's parent or official caregiver to sign a consent form. Please submit this form and we will send the link to the parent to sign later.

Electronic Signature (Type your name or Initials as your Electronic Signature ) *

Today's Date