St Marks Youth Ministry Registration

Youth Details

St Mark's Anglican Church Darling Point is exempt from the requirements of the Privacy Act 1988 (Cth) as it is a "small business". However, we seek to deal carefully with the personal information we collect and to do so in a manner consistent with your reasonable expectations. More information is set out in our privacy policy on our website.

The personal information in this form will be made available to - (a) the leaders involved in the running of the activities in which my child participates, and (b) medical and emergency services if considered necessary.

Child First Name *

Child Last Name *

Date of Birth *

School Grade *

School

Child Email Address

Child Mobile Number

Home Address

Home Address Line 2

Home City

Home Postcode

Home State

Home Country

Parent / Caregiver / Emergency Details

Parent / Caregiver 1 Name *

Parent / Caregiver 1 Phone *

Parent / Caregiver 1 Email *

Parent / Caregiver 1 Address (if different from above)

Emergency Contact Name and Relationship

Emergency Contact Phone

Parent / Caregiver 2 Name

Parent / Caregiver 2 Phone (if different from parent / caregiver 1)

Parent / Caregiver 2 Email (if different from parent / caregiver 1)

Parent / Caregiver 2 Address (if different from parent / caregiver 1)

Medical and Care

Medicare #

Does your child have any medical conditions that we should know about? (E.g. chronic illness; prescription medication; medical allergies; other)

Does your child have any care needs that we should know about? (E.g. behavioural concerns; psychiatric care; other)

Medicare Card Reference No:

Does your child have any special dietary need that we should know about? (E.g. food allergies)

Legal, Privacy, and Permissions

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

Legal Restriction Details

From time to time we may take photos or footage of the youth group for promotional material. Do you give permission for your child to visible in such materials? *

Under 18s Permissions. Permission to attend is required. Other permissions are at the discretion of the parent/caregiver.

Permission to attend all scheduled activities, unless I advise otherwise

Permission for leaders to obtain medical services in an emergency

YOUTH ONLY: Permission to make own way to and from youth activities

YOUTH ONLY: Permission to travel in approved leader's or other parent's car (full licence only; never alone with a driver; for relevant events where notice is given in advance)

Please confirm that the information given in this form is true and correct by typing your full name and date *