Hervey Bay Presbyterian Church

Youth Week Registration Form

Registration form

Hervey Bay Presbyterian Church – Youth Week Program

17  –  20 January 2017

(A form is needed for each child)

 

Name of Parent/Caregiver: _______________________________________________________

 

Contact details: Phone: ___________________ Mobile:  _____________________

 

Address: _______________________________________________

 

Doctor:  ___________________ Phone:  _____________________

 

Name of child: _______________________________________________________

 

Special needs: Allergies:  ______________________________________________

 

Medical condition/s: _____________________________________

 

Physical Restrictions: _____________________________________

 

I (parent/caregiver) _______________________________________  hereby give permission for my child (name above) to attend the Youth Activity Program of the Hervey Bay Presbyterian Church.  I understand that adult supervision will be provided and that all activities will be conducted in accordance with the Child Safe Protocols of the Presbyterian Church of Queensland (as outlined at http://www.pcq.org.au/childsafe.php)

 

Signed: _________________________________ Date:  _____________________________

 

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