Logos @ 360 Action Park • St John's Asquith

Trampoline/LaserTag Ticket + Grip Socks 0

Child details

Child First Name *

Child Last Name *

Parent's/Carer's details

Parent/Carer First Name *

Parent/ Carer Last Name *

Phone Number *

Email Address *

If an alternative carer will be the contact for the activity please list their name and phone number below.

Health information

Any allergies/ medical/ dietary/ behavioural issues we should be aware of for the activity?

Medicare Card Number

Medicare Reference Number

Medicare Expiry Date

Photos

Permissions for appearances in activity footage:

I give permission for photo/video of my child(ren) to be shown within St John's Church e.g. the end of year video shown on the final night of term. *

Yes

I give permission for photo/video of my child(ren) to be shown publicly e.g. St John's Church website, Logos Instagram page *

Yes

Permission

Do you give permission for your child to attend the 360 Action Park, Castle Hill with St John's Asquith Logos Youth Group on Friday 2 July 2026? Please note parents need to arrange transport to and from the venue where they will meet the youth leaders. *

yes

Have you signed the waiver for the 360 Action Park found at https://waiver.roller.app/360actionparkcastlehill/home ? *

yes

Please type your name below as your electronic signature giving permission for your child to attend this activity. *

Trampoline/LaserTag Ticket (NO Grip Socks) 0