Kruger Youth - Parental/Guardian Consent Form
Kruger Parade Baptist Church
2 Henderson St, Redbank 4301
Office: 3814 0144
Pastor's Mobile: 0434 050 222
Pastor's Email: seb@kruger.org.au
Member's Details
First Name *
Your answer
Last Name *
Your answer
Gender *
Date of Birth *
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School Grade *
Age *
Your answer
Address (including Suburb & Postcode) *
Your answer
Member's Mobile
Your answer
Member's Email
Your answer
Parent/Guardian Contact Details
For Emergency Contact and General Communication Purposes
Name (1st Contact) *
Your answer
Mobile (1st Contact) *
Your answer
Email (1st Contact)
Your answer
Relationship to Youth (1st Contact) *
Your answer
Name (2nd Contact)
Your answer
Mobile (2nd Contact)
Your answer
Email (2nd Contact)
Your answer
Relationship to Youth (2nd Contact)
Your answer
Medical Details
Medicare Number *
Your answer
Allergies
Your answer
Special Dietary Requirements
Your answer
Physical Limitations
Your answer
Are there any self-administered medications to be taken? *
If so please list details
Your answer
Do you give consent for us to administer paracetamol if required? *
Additional Medical Information
Your answer
Swimming skills *
ParentalGuardian Consent
I contest to:
my child being driven when necessary by an approved adult *
my child participating in activities/programs not on church grounds when specified *
my child being contacted by their relevant leader for the purpose of mentoring/pastoral care *
leaders choosing age appropriate movies up to the rating of and no more than the rating of M *
Photos/Videos
Photos and/or videos may be taken during our program that may include your child. These photos and/or videos may also be used for advertising and promotional purposes by Kruger Parade Baptist Church only. If you have any concerns regarding photos/videos please contact the church office.
Child Protection Statement of Commitment
Kruger Parade Baptist Church is committed to the safety and holistic wellbeing of all children and young people involved in our events. To ensure that young people are kept safe from harm, our staff and volunteers are required to possess a current blue card; agree to adhere to a code of conduct when working with children; and undergo training in child safe programs. Kruger Parade Baptist takes child protection and safety seriously and consequently has policies and procedures in place to ensure that your child has the best possible experience with us.

I understand that the youth leaders from Kruger Parade Baptist Church will take all responsible care of my child whilst at Kruger Youth and that Kruger Parade Baptist Church or its representatives will not be liable in any injury or accident, or for damage or loss of property. I give consent for and agree to pay for any necessary medical treatment. I understand that in cases of unacceptable behaviour my child will be sent home.

I understand that in signing these forms I give consent for my child to participate in the Kruger Youth program.

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Required
Name of Parent/Guardian *
Your answer
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Required
Date *
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