Countdown To Christmas - Children's Christmas Activities for Prep to Grade 6. Saturday 8th December 2018. 5.00pm - 7.30pm. Run by the Uniting Churches of the Hobart Region.
The below registration and indemnity form are an important part of ensuring the safety of all children who come along to 'Countdown To Christmas'. By filling in this form and submitting it you are giving permission for your child/ren to participate fully in the program. You also acknowledge that the nature of activities of the day will involve group and individual activities which may include but not limited to: drama; music; art, indoor and outdoor games; cooking; eating; and Bible input stories and discussions from a Christian perspective. Unforeseen and unavoidable risks may occur during these activities. You also release the 'Uniting Church in Australia' employees, leaders and representatives from any liability of unintended or unexpected accidents or incidents which might occur during participation in the program. In the event of accident or illness to your child/ren you give permission for those in charge to obtain medical assistance or treatment as may be necessary and to engage any medical professionals, including ambulance and hospital and agree to pay for same. If any incident does occurs please be aware that we will make contact with the emergency contact person as soon as is practicable. All leaders will meet the high standard required of leaders in the church and also have a current Working With Vulnerable People Church.


Please tick to acknowledge that you have read and accept the above disclosures, procedures, risks and indemnities in relation to your child/ren attending and participating in this activity of Hobart North Uniting Church. *
Required
COUNTDOWN TO CHRISTMAS - CHILD DETAILS
Child 1
First Name *
Your answer
Last Name *
Your answer
Date of Birth (date/month/year) *
Your answer
School Year *
Your answer
Child 2
First Name
Your answer
Last Name
Your answer
Date of Birth (date/month/year)
Your answer
School Year
Your answer
Child 3
First Name
Your answer
Last Name
Your answer
Date of Birth (date/month/year)
Your answer
School Year
Your answer
Child 4
First Name
Your answer
Last Name
Your answer
Date of Birth (date/month/year)
Your answer
School Year
Your answer
Child 5
First Name
Your answer
Last Name
Your answer
Date of Birth (date/month/year)
Your answer
School Year
Your answer
COUNTDOWN TO CHRISTMAS - REGISTRATION - PARENT OR GUARDIAN DETAILS
Parent or Guardian Full Name *
Your answer
Email Address
Your answer
Address (Number and Street) *
Your answer
Suburb *
Your answer
Phone Number 1 *
Your answer
Phone Number 2
Your answer
COUNTDOWN TO CHRISTMAS - EMERGENCY CONTACT DETAILS
Emergency Contact Person 1 Name *
Your answer
Emergency Contact Person 1 Contact Details *
Your answer
Emergency Contact Person 2 Name
Your answer
Emergency Contact Person 2 Contact Details
Your answer
IMPORTANT INFORMATION
Please list any information that we may need to know about your child/ren. For example but not limited to: medical; allergies; special needs; medication; foods they cannot eat; needing to carry an epicene; anxieties; custody arrangements, or anything else we need to be aware of. List the child then the required information; then do the same for each as necessary.
Your answer
MEDIA AGREEMENT
I understand that my child/ren may be photographed or recorded on video during the course of church programs and/or events. By indicating below, I provide consent for their image to be used in either print, electronic, or video form for the promotional purpose of future church based activities and/or to be used to report back to the congregation some of the ministry activities of the church. Children's names and photos will not be used together and you are free at all times to view what is held for these purposes.
Please tick to as appropriate. *
Required
SIGNATURE
Please type your name below and the date of entry, as an electronic signature of the person filling in and submitting this form.
Name of Signing Person *
Your answer
Date Completed. *
MM
/
DD
/
YYYY
Registrations are limited to 50 children. Once the limit is reach your child/ren will be placed on a waiting list and you will be contact to let you know this. Payment can be made on the day when dropping off your children. Drop off time is from 4.45pm and the pickup is 7.30pm. Payment to be received on the night, $2 per child max $5 per family.
For further details please contact the Rev'd Jeff Savage on 0429 728 243 or jeff@hobartnorth.ucatas.org
Submit
Never submit passwords through Google Forms.
This form was created inside of Hobart North Uniting Church. Report Abuse - Terms of Service