Kids' Club Permission Form 2018
Welcome to Kids' Club
Kids’ Club runs on Friday afternoons during school terms. We meet in the Church Hub (10 Bluett Drive, Smeaton Grange), from 4:30-6:00pm. If you have any questions about Kids' Club please contact Mel Gillies on mel.gillies@gmail.com.
Child Details
Please fill in your details below. The information contained in this form will be treated confidentially. If you wish to access this information or have any queries, please do not hesitate to contact us.
Full Name - Child 1 *
Please enter your child's full name
Your answer
Year at School - Child 1 *
Please choose your child's school year from the list
Full Name - Child 2
Your answer
Year at School - Child 2
Full Name - Child 3
Your answer
Year at School - Child 3
Full Name - Child 4
Your answer
Year at School - Child 4
Allergies/special needs
Child 1
Your answer
Child 2
Your answer
Child 3
Your answer
Child 4
Your answer
Parent / Guardian Details
Parent/Guardian Name (primary contact) *
Your answer
Email *
Enter your email address to receive Kids' Club updates
Your answer
Phone Number (primary contact) *
Enter a contact number - preferably a mobile
Your answer
Parent/Guardian Name (secondary contact)
Your answer
Phone Number
Your answer
Address Details *
Street
Your answer
Suburb
Your answer
Post code
Your answer
Other Emergency Contact
Please enter the name of an additional person to contact if the parents/guardians are unavailable.
Your answer
Phone Number
Your answer
Is anyone restricted from seeing your child/children?
If yes please provide details. All information is kept in strict confidence.
Your answer
Permission Details
Parents/Guardians - PLEASE READ and click on Submit below *
In the unlikely case of an emergency, I understand that Kids’ Club Leaders will make every effort to contact parents/guardians using the details above. If for some reason contact is not possible, I give permission to the doctor chosen by the Kids’ Club leaders to secure proper treatment for my child as named. I also understand that photos may be taken of my child at Kids’ Club to be used solely within the group unless specific permission is sought. By submitting this form, I give permission for my child/ren to participate in Kids’ Club run by Harrington Park Anglican Church. (Please select today's date and "Submit")
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