HBC 2019 Kids Application Form
Any children in GRADE 1-6 who would like to join the Riverside Community Church Holiday Bible Club (HBC) must complete the form below.
Child's name
Your answer
Child's surname
Your answer
Child's Gender
Child's date of birth
MM
/
DD
/
YYYY
Child's grade
What school does your child attend?
Your answer
Home suburb
Your answer
Postal Address
Your answer
Parent details
Mom / Dad name and surname
Your answer
Parent cell number
(of the parent above)
Your answer
Parent email
(of parent above)
Your answer
Emergency contact
Name, Surname
Your answer
Emergency contact cell number
Your answer
Emergency contact relationship
Your answer
Allergies or other conditions we should be aware of (food reactions, physical limitations, ADD/ADHD, etc) This will remain confidential.
Your answer
Parental Permission: I understand that all reasonable precautions will be taken to ensure my child's safety, and hereby release the church from any claims in the case of accident or injury. *
Authorisation for Emergency Medical Care: I authorise the Riverside Community Church and/or adult members who are representatives of the church to give consent for any and all necessary emergency medical care for my child, while in the church's custody for the above event
Photo Release : I understand that my child (under 18) might be photographed and/or videotaped during their participation in activities and programs organised by the Riverside Community Church and authorise such photographs and/or videotapes to be used by the church for ministry‐related presentations. I understand that my child's name will not be used and/or published in any way, and that no compensation will be given for the use of such photographs and/or videotape
Please type your first and last name to signify your agreement with the above statements
Your answer
Date of application
Your answer
Parent's please note that a hard copy indemnity form will have to be completed and signed when you drop your child at HBC before we allow your child into our care. Without a signed indemnity form no child will be permitted to take part at HBC. *
Required
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