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:
Member's Details
First Name *
Last Name *
Gender *
Date of Birth *
School Grade *
Age *
Address (including Suburb & Postcode) *
Member's Mobile
Member's Email
Parent/Guardian Contact Details
For Emergency Contact and General Communication Purposes
Name (1st Contact) *
Mobile (1st Contact) *
Email (1st Contact)
Relationship to Youth (1st Contact) *
Name (2nd Contact)
Mobile (2nd Contact)
Email (2nd Contact)
Relationship to Youth (2nd Contact)
Medical Details
Medicare Number *
Special Dietary Requirements
Physical Limitations
Are there any self-administered medications to be taken? *
If so please list details
Do you give consent for us to administer paracetamol if required? *
Additional Medical Information
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 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.
Name of Parent/Guardian *
Date *
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