HBC 2019 Registration Form
Holiday Bible Club: 15 - 17 January 2019
131 Gunnedah Road, Taminda, Tamworth NSW
Contact us: Sam Blaxland 0491 119 982 / Gabby West 0478 638 003

Sponsored by Tamworth Bible Baptist Church
Free Entry

Ages 6-13

Child's information
Last name *
Your answer
Given name(s) *
Your answer
Age in January 2019 *
Your answer
Gender *
Allergies or medical conditions *
Your answer
Family information
Parent/Guardians' name(s) *
Your answer
Address *
Your answer
Best contact phone number *
Your answer
Second contact phone number
Your answer
Your answer
Emergency Contact
Emergency Contact's name *
Your answer
Emergency Contact's phone *
Your answer
Participation details
Which days will you attend? *
Will you require transportation? *
Parent/Guardian's Agreement
I understand that all reasonable care will be taken to protect the well-being of the participants in this HBC and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the HBC team, or other associated volunteers of the HBC program to obtain medical care from a hospital or licensed medical provider for my child in the event that myself or other legal guardian(s) cannot be contacted.
I, the legal parent/guardian of the above named child, agree to the terms defined in the Guardian's Agreement above *
Image consent *
Unless other written instruction is submitted, I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the HBC event or for future advertisement of Tamworth Bible Baptist Church HBC programs. Any other use will require my further consent.
A written signature from the parent/guardian will also be required before the child begins participation in this HBC 2019. A paper form will be provided at the event venue (131 Gunnedah Road, Taminda, Tamworth NSW).
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