GosfordPC Youth Registration 2023

Gosford Presbyterian Church

GosfordPC Youth

Please complete one Registration Form per child

Child's Details

Last Name *

First Name *

Date of Birth *

Gender

Home Address *

Home City *

Home State *

Home Postcode *

School Grade in 2023?

School Grade *

Custody Orders?

Is there a court/custody order on this child.? *

Yes

If there is a court/custody order on this child, please provide appropriate details

1st Parent / Carer's Contact Details

Parent / Carer's Surname *

Parent / Carer's First Name *

Parent / Carer's email

Parent / Carer's Phone Number (Mobile) *

Parent / Carer's Phone Number (Hm)

2nd Parent / Carer's Contact Details

(NB. 2nd Parent/ Carer's Details are not essential, but if provided will be used as a secondary contact should the 1st parent be unavailable).

2nd Parent / Carer's Surname

2nd Parent / Carer's First Name

2nd Parent / Carer's eMail

2nd Parent / Carer's Phone Number (Mobile)

2nd Parent / Carer's Phone Number (Hm)

Medical Details

Does your child have any of the following conditions? If so, please specify.

Allergies

Dietary Needs

Asthma?

Yes

Self administered medications

Other relevant medical information?

Emergency Contact Details

Doctor's Name

Doctor's Address

Doctor's Contact Number

Emergency Contact Name (will only be used if we cannot contact you or 2nd parent). *

Relationship to child? *

Contact Number *

General Information.

Administration of Medicines and Medical Emergencies

I understand that no medications will be administered to my child during the program unless I specifically request and authorise such administration. I understand that it is my responsibility to provide any such medication.

I authorise the leaders of this program, in the event of an emergency, to obtain at my expense any medical, ambulance or similar services. I understand that this authorisation will not be used unless I am unable to be contacted at the time of the emergency, or am unable to give permission at that time.

Transport to and from GosfordPC Youth

I accept that I am responsible for providing/organising transport to and from GosfordPC Youth for my child/ren. If I am unable to do so, I consent to my child/ren walking to and/or from GPC. *

Yes

Unacceptable Behaviour

I accept that any unacceptable behaviour on the part of my child may result in my child being temporarily or permanently prohibited from attending this program.

Correctness of Information

I confirm that the information contained on this Registration Form is true and correct.
I agree that I will ensure that any changes to this information are advised in writing as soon as possible.

Privacy and Child Protection

Any personal and sensitive information collected will be used only for purposes relating to the spiritual, pastoral, social, educational, administrative, legal and historical functions of the Church in accordance with the PCNSW‘s Privacy Policy in accordance with the Privacy Amendment (Private Sector) Act 2000. Your acceptance of this written advice will be regarded as your consent to collect and so use the information as described. If you do not consent please advise the GosfordPC Youth leaders immediately. A copy of the PCNSW‘s Privacy Policy is available on request from the GPC Session Clerk. Personal information will not be used for any other purpose without first obtaining your consent.

The Children’s Ministry leadership team is bound by the Code of Conduct of the “Breaking the Silence” procedures of the Presbyterian Church of NSW.

I have read and understood the above General Information. *

Yes

Signature

Enter name of person completing this form

Date