TOMS Youth 2020 Registration Form - Confidential • TOMS Anglican Churches

2020 Registration Form

DETAILS OF CHILD

Last Name *

Date of Birth *

Contact email (or Parent/Guardian email) *

First Name *

Gender *

Street Address *

Suburb *

Current School Year *

Parent/Guardian Name *

Postcode *

Current School *

Parent/Guardian Contact Number *

Is there anyone legally restricted from seeing the child?

CHILD'S HEALTH INFORMATION

Emergency Contact - Name (if parent/guardian cannot be reached) *

Family Doctor (Name and phone number) *

Non-Parent Emergency Contact - Number *

Medicare details (Card Number, Reference Number, Expiry Date) *

Please detail any relevant health information (eg. Allergy, Medication, Disability, Restricted activities, Behavioural issues)

During the activities of TOMS Youth photos/video may be taken. I give permission for photos/footage of my child to be used when advertising the group *

PARENT/GUARDIAN CONSENT

By submitting this form I indicate my permission for:

my child to participate fully in the regular activities of TOMS Youth run by TOMS Anglican Churches at 29 Callisto Drive in Cranebrook, 7:00-9:00pm on Fridays during school terms.
in the case of a medical emergency, the Doctor chosen by the church authorities or other persons supervising or administering the TOMS Youth activity, to secure proper treatment for and/or order hospitalisation, injection, anaesthetic, or surgery for my child as named. I understand that every effort will be made to contact me prior to instituting such procedures.

The leadership team of TOMS Youth will treat the information contained above confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. If you wish to access this information or have any queries in relation to the manner in which we handle your personal information, please do not hesitate to contact us.