Hills Youth Risk Management 2024 (form D)

This information is treated confidentially and for the sole purpose of supporting the safety of your child or young person

Child / Youth Information

First Name *

Last Name *

Date of Birth *

School Grade *

School *

Street Address *

Home City *

Home State *

Home Postcode *

Child Mobile Number

Child Email Address

Child Home Phone Number

Medical conditions, allergies or impairments (please include directions for treating conditions if needed)

Details of court orders or custody issues

Parent / Guardian Information

First Name *

Mobile *

Last Name *

Address (if different from child address)

If you would like to add a second emergency contact, please tick below.

Yes

First Name *

Mobile *

Last Name *

Address (if different from child address)

I give permission for my child / young person to participate in Hills Youth activities. I understand that the church will take reasonable steps to provide a safe environment for my child.

I understand that during activities my child / young person may have photos taken of them during various activites. I give my consent for Hills Church to use these photographs for promotional purposes.

Do you give consent for photos to be used as described above? *

I consent to the church providing my child with any medical treatment they might reasonably require while they are under the church’s care (e.g. applying ice to a bruise or sprain, applying a bandaid or stabilising an injury while waiting for emergency medical assistance). I also consent to the church obtaining emergency medical assistance for my child where considered necessary (including by ambulance or hospital attendance). I have informed the church of any special circumstances that might be relevant to my child’s care, including relevant allergies and necessary medications. I agree to pay all medical treatment expenses incurred by the church on my child's behalf.

By ticking below you agree to the above statement *

I agree to the above statement