Family Registration form • The Lakes Church

FAMILY REGISTRATION

Child's Information

First Name *

Last Name *

Date of Birth *

Gender *

School Name *

School Grade

(optional) Teenagers only - Email Address to receive direct Lakes Crew Youth updates

Which of our kids programs may your child attend this year?

Please tick: *

Koala Kids Playgroup (weekdays)

Lakes Kids (Sundays)

Lakes Crew Youth (Friday nights)

Child's Home Address

Please select one of the following options: *

We live in the Cairns region

We are here on holidays/visiting

Home Address *

Suburb *

State *

Postcode

Medical & Safety Information

If your child has any allergies, medical or psychological conditions or other special needs please give details of condition below (e.g. severity/treatment).

Children must be signed in and out of the program by a responsible adult. Please list any person you DO NOT authorise to sign your children in/out (e.g. when access to a child is restricted by a court order).

Parent/Carer Information

Parent/Carer 1

Relationship to Child *

First Name *

Last Name *

Email Address *

Mobile Number *

Parent/Carer 2

Relationship to Child

First Name

Last Name

Email Address

Mobile Number

Emergency Contact Details

If we are unable to contact you or your children's other parent/carer you authorise the following person to direct us regarding the care of your children.

Relationship to Child *

Name *

Mobile number *

Parent/Carer Agreement

I understand that The Lakes Church will take all reasonable care to ensure the comfort and safety of my children, however all hazards and dangers associated with the program's activities cannot be foreseen or may be beyond the control of the church, its leaders or staff.

In the event of an emergency, I authorise the leaders to obtain medical assistance and I accept responsibility for payment of any associated costs.

I understand that photographs and/or video may be taken during the course of the program and that these images may be used in information about the program in print and online. I will advise the church in writing via office@thelakes.org.au if I wish my child to be excluded.

Parent/Carer name *

Today's Date *

Register additional children OR Submit after all children's details have been entered.