Fairy Meadow Kids & Youth Registration Form
Which group is this child/youth attending?
Which activity?
Playpatch (Friday Morning)
Kids' Club (Friday afternoon)
Youth group (Friday night)
Kids' Church (Sunday morning)
Child's Details
First Name
Last Name
Date of Birth
Gender
Male
Female
School Grade
-- None --
Pre-school
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Name of School
Mobile Number
Parent/Guardian Contact Details
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Relationship to Child
Allergies (list)
Nuts
Gluten
Egg
Dairy
Bees
Allergies (other)
Medicare Card Number
Child's Number on card (eg 3)
Medical Information
Tip: anything that we need to know about medications/health?
I give permission for photos & videos of my child to be taken during church activities and used in promotions
Yes
No
Anything else we need to know?
Remove
Add Another Person
Submit