GLUE SAndWICH Visitor Registration

First Name *

Preferred Name

Last Name *

Date of Birth

School Grade *

Address

Suburb

Post Code

Email Address

Mobile Number

Parent/Guardian Details

Parent/Guardian #1(Primary contact) *

#1 Contact Number *

#1 Email *

#1 Relationship to Child

Parent/Guardian #2

#2 Contact Number

#2 Email

#2 Relationship to Child

Emergency Contact

Name

Relationship to Participant

Contact Number

Address

Authorised to Collect Child: Yes/No

Medical Conditions/Allergies

Are there any medical conditions or allergies the leaders need to be aware of? (e.g. Diabetes; Asthma; ADHD; Epilepsy; Other - please specify)

Does your child have an asthma or anaphylaxis management plan?

Will your child have any medication?

Does your child have any special food requirements?

Is there anything else we need to know about you?

Permissions

I consent to my youth's participation in GLUE SAndWICH activities. I will encourage my child to participate and co-operate with the leaders and other participants.

I consent to my youth's participation in online activities using social media platforms, including Zoom, YouTube, Facebook, Discord, messaging services, emails etc (Please be aware that some of these platforms require individuals to be 13 years of age). I understand there will always be at least two approved adults in attendance. I understand there will be NO on-on-one online communication with children in this arrangement.

I give permission for my child to participate in activities outside offsite.

I give permission for my child to be transported in private cars arranged by the leaders as necessary for the program.

I authorise the leaders in charge of any activity conducted by Ormond Anglican to consent on my behalf, where it is impractical to communicate with me, for my child to receive medical or surgical treatment as may be deemed necessary. I am also responsible for the cost of any medical treatment deemed necessary.

I understand there may be photographs and video footage taken of my child during activities and am willing for my child to be filmed in appropriate settings. I am willing for these photos or footage to be used within Ormond Anglican to promote the ministry in a way that does not identify their name and details. I accept that photographs may be published in the weekly news and on the Ormond Anglican website. My child is also willing for this to take place.

I understand that church services may be streamed live. I am willing for my child to appear in a livestreamed service. I acknowledge that the proceedings may be available for viewing after services have concluded.

Names of people allowed to collect my child in the event that I am unable

I Agree *

Yes

Parent/Guardian Signature *