Max Life Kids' Registration Kingston • Max Life Church

CHILD DETAILS

Child's First Name *

Preferred Name if different from above

Child's Surname *

Male/Female *

Campus location

Naracoorte - Max Life Church

Kingston - Max Life Church

Child's Date of Birth *

Country of Birth

School Grade

Age *

Child's Home Address *

Home City *

Dietary Requirements

Medical or other information we may need to know about the child ie allergies inc. Asthma, Food allergies, Medical concerns, Special Needs, Disability/modifications needed, 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 Anita Hutchesson ph 0439847179 or Karyn Vanstone ph 0429890007 if you have particular concerns

Is the child toilet trained?

Child is toilet trained and can use toilet independently mostly

Child is toilet training, please contact me if they need assistance using toilet

Child wears nappies, please contact me if need changing

Other personal needs of child eg. uses dummy, needs assistance to wash hands, has a comfort toy, special interest?

First and Surname of Primary Parent/ Legal Guardian *

Relationship to Child *

Parent/Guardian's phone *

Parents' Email Address

First and Surname of other Alternative Emergency Contact *

Emergency Contact's Relationship to Child *

Emergency Contact's phone number *

PARENT CONSENT- Please tick and sign electronically

Please select *

I am the PARENT/LEGAL GUARDIAN of the child

This child is IN MY CARE for the day

By selecting 'yes' I give permission for my child/dependent to be photographed or videoed at Max Life Church 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 to participate in Max Life Kids weekly Program 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 my child/dependent whilst in their care. In the event of injury or illness to my child/dependent and if parents can't be notified, 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. *

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

If child is going to attend Max Life Kids' regularly we will need the child's parent or legal guardian 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