Kids Club July 2022 • Revival Church

1 Day 0

CHILDS DETAILS

PARENT/GUARDIAN DETAILS

Parent / Guardian First Name *

Parent / Guardian Last Name *

Email Address *

Phone Number *

Address

Suburb

Post code

State

EMERGENCY CONTACT DETAILS

Emergency Contact Name *

Emergency Contact Number *

ADDITIONAL INFORMATION

The cost of the Kids Club is $20 per child per day. Children are required to bring their own recess and lunch.

Because of our duty of care to children and parents with babies who attend Kids Club, it is important to notify us if your child has NOT been immunised in accordance with the recommendation made by the NSW Department of Health. This will allow us to notify the parents of children whose boys and girls are too young to be immunised. Discretion will be used at all times.

My Child is immunised *

Yes

No

CONSENT

I leave my child/children in the care of Revival Church between the hours of 9:00 am & 3:00 pm, on the dates specified. I have explained to my child that he/she must obey the requests of the Kids Club 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 3:00 pm.

Consent *

An email will be sent to you after you click Submit, with details on the Kid's Club.

To register additional children, click the Submit button, then click the "Go back to the form" link and complete for the next child.

All information obtained will be kept in confidence & will only be used for follow-up & pastoral care. For more information or assistance in filling out this form, please email josie.hobbs@rlcweb.org.au

2 Days 0

CHILDS DETAILS

PARENT/GUARDIAN DETAILS

Parent / Guardian First Name *

Parent / Guardian Last Name *

Email Address *

Phone Number *

Address

Suburb

Post code

State

EMERGENCY CONTACT DETAILS

Emergency Contact Name *

Emergency Contact Number *

ADDITIONAL INFORMATION

The cost of the Kids Club is $20 per child per day. Children are required to bring their own recess and lunch.

Because of our duty of care to children and parents with babies who attend Kids Club, it is important to notify us if your child has NOT been immunised in accordance with the recommendation made by the NSW Department of Health. This will allow us to notify the parents of children whose boys and girls are too young to be immunised. Discretion will be used at all times.

My Child is immunised *

Yes

No

CONSENT

I leave my child/children in the care of Revival Church between the hours of 9:00 am & 3:00 pm, on the dates specified. I have explained to my child that he/she must obey the requests of the Kids Club 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 3:00 pm.

Consent *

An email will be sent to you after you click Submit, with details on the Kid's Club.

To register additional children, click the Submit button, then click the "Go back to the form" link and complete for the next child.

All information obtained will be kept in confidence & will only be used for follow-up & pastoral care. For more information or assistance in filling out this form, please email josie.hobbs@rlcweb.org.au

3 Days 0

CHILDS DETAILS

PARENT/GUARDIAN DETAILS

Parent / Guardian First Name *

Parent / Guardian Last Name *

Email Address *

Phone Number *

Address

Suburb

Post code

State

EMERGENCY CONTACT DETAILS

Emergency Contact Name *

Emergency Contact Number *

ADDITIONAL INFORMATION

The cost of the Kids Club is $20 per child per day. Children are required to bring their own recess and lunch.

Because of our duty of care to children and parents with babies who attend Kids Club, it is important to notify us if your child has NOT been immunised in accordance with the recommendation made by the NSW Department of Health. This will allow us to notify the parents of children whose boys and girls are too young to be immunised. Discretion will be used at all times.

My Child is immunised *

Yes

No

CONSENT

I leave my child/children in the care of Revival Church between the hours of 9:00 am & 3:00 pm, on the dates specified. I have explained to my child that he/she must obey the requests of the Kids Club 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 3:00 pm.

Consent *

An email will be sent to you after you click Submit, with details on the Kid's Club.

To register additional children, click the Submit button, then click the "Go back to the form" link and complete for the next child.

All information obtained will be kept in confidence & will only be used for follow-up & pastoral care. For more information or assistance in filling out this form, please email josie.hobbs@rlcweb.org.au