RLC Kid's Church Registration

Child's Details

Child's First Name *

Child's Last Name *

Gender *

Date of Birth *

School Grade *

Name of School

Allergies

Parent/Guardian Details

Title

Parent/Guardian First Name *

Parent/Guardian Last Name *

Phone Number *

Mobile Number

Email Address *

Home Address *

Home City *

Home State *

Home Post Code *

How did you hear about RLC Kid's Church?

Would you approve of your child receiving information from Revival Life Centre to the above mail address? *

YES

Emergency Contact Details

Name *

Best Contact Number *

Consent

I leave my child/Children in the care of Revival Life Centre Penshurst between the hours of 10:30am to 12:00pm of a Sunday morning. I have explained to my child that he/she must obey the requests of the Junior Church team to ensure their safety & wellbeing. I give permission for the First Aid officer to administer treatment if deemed necessary. I will be the person responsible for collecting my child at the end of the service

Consent *

I agree and accept the above

Please complete a separate form for each child you wish to register. All information obtained will be kept in confidence & will only be used for follow-up & pastoral care. For for information, or assistance in filling out this form, please email Marilyn@rlcweb.org.au.