St John's Holiday Kids' Club • St John's Asquith

WHOLE WEEK Monday 14 to Thursday 17 April 0

Child's details

First Name *

Last Name *

School

School Grade *

Child's needs

Allergies/medical issues? Please list any that apply to this child, and if any medication will be required to be stored onsite.

Additional support needs/behavioural issues? Please list anything that it would be helpful for the leaders to know to be able to support your child.

Dietary issues? Anything we should know about when doing food/cooking activities?

Medicare Card Number *

Medicare Reference Number *

Parent/Carer's details

Completion of this form acknowledges the permission of the Parent/Carer listed below for the Child as named above to participate fully in the St John's Kids Club afternoon activites.

Parent/Carer's full name *

Email Address *

Mobile Number *

Photo permissions

Photo permission #1 - I give permission for photos/videos taken of my child at Kids Club to be shown internally at St John's Church e.g. pictures on a powerpoint about the Kids Club shown during a Sunday service *

Photo permission #2 - I give permission for photos/videos taken of my child at Kids Club to be shown externally e.g. Church website, social media *

Medical Permission

Completion of this form acknowledges that I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand that every effort will be made to contact me or the listed emergency contact person for this child prior to instituting such procedures.

Drop off/Pick up Permissions

Anyone else (including the child's other parent) who has permission to drop off/pick up this child? Please list their name and contact number. Children will only be allowed to leave with other adults if we have your written permission for them to do so.

Anyone who is legally prohibited from collecting this child? If so, please provide details.

Alternative emergency contact

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

How did you hear about Kids Club? *

Monday 14 April 0

Child's details

First Name *

Last Name *

School

School Grade *

Child's needs

Allergies/medical issues? Please list any that apply to this child, and if any medication will be required to be stored onsite.

Additional support needs/behavioural issues? Please list anything that it would be helpful for the leaders to know to be able to support your child.

Dietary issues? Anything we should know about when doing food/cooking activities?

Medicare Card Number *

Medicare Reference Number *

Parent/Carer's details

Completion of this form acknowledges the permission of the Parent/Carer listed below for the Child as named above to participate fully in the St John's Kids Club afternoon activites.

Parent/Carer's full name *

Email Address *

Mobile Number *

Photo permissions

Photo permission #1 - I give permission for photos/videos taken of my child at Kids Club to be shown internally at St John's Church e.g. pictures on a powerpoint about the Kids Club shown during a Sunday service *

Photo permission #2 - I give permission for photos/videos taken of my child at Kids Club to be shown externally e.g. Church website, social media *

Medical Permission

Completion of this form acknowledges that I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand that every effort will be made to contact me or the listed emergency contact person for this child prior to instituting such procedures.

Drop off/Pick up Permissions

Anyone else (including the child's other parent) who has permission to drop off/pick up this child? Please list their name and contact number. Children will only be allowed to leave with other adults if we have your written permission for them to do so.

Anyone who is legally prohibited from collecting this child? If so, please provide details.

Alternative emergency contact

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

How did you hear about Kids Club? *

Tuesday 15 April 0

Child's details

First Name *

Last Name *

School

School Grade *

Child's needs

Allergies/medical issues? Please list any that apply to this child, and if any medication will be required to be stored onsite.

Additional support needs/behavioural issues? Please list anything that it would be helpful for the leaders to know to be able to support your child.

Dietary issues? Anything we should know about when doing food/cooking activities?

Medicare Card Number *

Medicare Reference Number *

Parent/Carer's details

Completion of this form acknowledges the permission of the Parent/Carer listed below for the Child as named above to participate fully in the St John's Kids Club afternoon activites.

Parent/Carer's full name *

Email Address *

Mobile Number *

Photo permissions

Photo permission #1 - I give permission for photos/videos taken of my child at Kids Club to be shown internally at St John's Church e.g. pictures on a powerpoint about the Kids Club shown during a Sunday service *

Photo permission #2 - I give permission for photos/videos taken of my child at Kids Club to be shown externally e.g. Church website, social media *

Medical Permission

Completion of this form acknowledges that I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand that every effort will be made to contact me or the listed emergency contact person for this child prior to instituting such procedures.

Drop off/Pick up Permissions

Anyone else (including the child's other parent) who has permission to drop off/pick up this child? Please list their name and contact number. Children will only be allowed to leave with other adults if we have your written permission for them to do so.

Anyone who is legally prohibited from collecting this child? If so, please provide details.

Alternative emergency contact

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

How did you hear about Kids Club? *

Wednesday 16 April 0

Child's details

First Name *

Last Name *

School

School Grade *

Child's needs

Allergies/medical issues? Please list any that apply to this child, and if any medication will be required to be stored onsite.

Additional support needs/behavioural issues? Please list anything that it would be helpful for the leaders to know to be able to support your child.

Dietary issues? Anything we should know about when doing food/cooking activities?

Medicare Card Number *

Medicare Reference Number *

Parent/Carer's details

Completion of this form acknowledges the permission of the Parent/Carer listed below for the Child as named above to participate fully in the St John's Kids Club afternoon activites.

Parent/Carer's full name *

Email Address *

Mobile Number *

Photo permissions

Photo permission #1 - I give permission for photos/videos taken of my child at Kids Club to be shown internally at St John's Church e.g. pictures on a powerpoint about the Kids Club shown during a Sunday service *

Photo permission #2 - I give permission for photos/videos taken of my child at Kids Club to be shown externally e.g. Church website, social media *

Medical Permission

Completion of this form acknowledges that I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand that every effort will be made to contact me or the listed emergency contact person for this child prior to instituting such procedures.

Drop off/Pick up Permissions

Anyone else (including the child's other parent) who has permission to drop off/pick up this child? Please list their name and contact number. Children will only be allowed to leave with other adults if we have your written permission for them to do so.

Anyone who is legally prohibited from collecting this child? If so, please provide details.

Alternative emergency contact

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

How did you hear about Kids Club? *

Thursday 17 April 0

Child's details

First Name *

Last Name *

School

School Grade *

Child's needs

Allergies/medical issues? Please list any that apply to this child, and if any medication will be required to be stored onsite.

Additional support needs/behavioural issues? Please list anything that it would be helpful for the leaders to know to be able to support your child.

Dietary issues? Anything we should know about when doing food/cooking activities?

Medicare Card Number *

Medicare Reference Number *

Parent/Carer's details

Completion of this form acknowledges the permission of the Parent/Carer listed below for the Child as named above to participate fully in the St John's Kids Club afternoon activites.

Parent/Carer's full name *

Email Address *

Mobile Number *

Photo permissions

Photo permission #1 - I give permission for photos/videos taken of my child at Kids Club to be shown internally at St John's Church e.g. pictures on a powerpoint about the Kids Club shown during a Sunday service *

Photo permission #2 - I give permission for photos/videos taken of my child at Kids Club to be shown externally e.g. Church website, social media *

Medical Permission

Completion of this form acknowledges that I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand that every effort will be made to contact me or the listed emergency contact person for this child prior to instituting such procedures.

Drop off/Pick up Permissions

Anyone else (including the child's other parent) who has permission to drop off/pick up this child? Please list their name and contact number. Children will only be allowed to leave with other adults if we have your written permission for them to do so.

Anyone who is legally prohibited from collecting this child? If so, please provide details.

Alternative emergency contact

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

How did you hear about Kids Club? *