NPC Kids Club Registration • Noosa Presbyterian Church

NPC Kids Club Registration Form

Welcome to Noosa Presbyterian Church Kids Club! We are thrilled that your child(ren) will be joining us!

We're deeply committed to providing a fun, caring and safe environment for them to enjoy, and to help us do this, we ask that you complete the following registration form. You can add multiple children to the one form using the "Add another child" button at the bottom, and the form is valid for the whole calendar year.

As a member of the Presbyterian Church of QLD (PCQ) we have implemented the PresSafe Child Protection policy. For more information about our child protection policies, please visit the Parnet Information page on the Pressafe website.

If you ever have any questions or concerns about Kids CLub, please don't hesitate to get in touch:

Kids Club Co-ordinator
Bec Koplick
0412 368 856
bec@koplan.com.au

Church Pastor
Phil Stolk
0493 564 605
phil@noosapc.org.au

Parent / Caregiver Details

First Name *

Last Name *

Home Address *

Home Address Line 2

Home Suburb *

Home Post Code *

Phone Number *

Email Address

Emergency Contact

Emergency Contact & Relationship *

Tip: Must be a different person to parent/caregiver listed above

Emergency Contact Phone Number *

Child's Details

First Name *

Last Name *

Date of Birth *

Your relationship to child *

Does child live at a different address to the one provided above? *

Yes

Child Address *

Child Suburb *

Child Postcode *

Does your child have any medical or behavioural issues that leaders should be made aware of? *

Yes

Please specify *

Tip: For allergies, please indicate their severity i.e., mild, moderate, severe or anaphylactic, what triggers the reaction (inhalation, physical contact, ingestion) and how the reaction presents in your child.

Is your child subject to a custody order? *

Yes

Please provide details: *

Photographs

Do you give permission for your child's photograph to be taken and used for promotional purposes? (Select all that apply) *

No. I do not give permission for my child to be photographed

Yes. Photos of my child may be published for internal church use (e.g. printed and displayed in church building or in newsletter)

Yes. Photos of my child may be published externally (e.g. flyers, church website)

Privacy Declaration

I give permission for the personal details given herein to be provided to appropriate leaders and/or relevant medical/emergency services as deemed necessary.
I understand the details given herein may be used by leaders to contact myself and that the details will not be given to any third party, except as provided above.

Privacy Declaration *

I consent

Authorisations & Expectations

By completing this form, I hereby give permission for my child/ren to attend all scheduled activities this year, unless we explicitly advise the leadership team otherwise.
In doing so I undertake to provide the leaders with any information relevant to the wellbeing of my child/ren prior to them attending any and all scheduled activities.
I understand that every effort will be made to provide a safe environment, however in signing this form I authorise the leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue or other services considered necessary.
I also acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my child/ren being sent home &/or being temporarily or permanently prohibited from attending the activities of this group.

Consent *

I consent

Today's date *