DPC PresSafe Enduring Permission Kids and Youth

Child Information

First Name *

Preferred Name

Last Name *

Gender

Date of Birth *

Mobile Number

Email Address

Home Address *

Home Address Line 2

Home Suburb

Home State

Home Post Code

School

School Grade

Does your child attend church anywhere?

If DPC which service do you attend?

8:15am

10:30am

5pm

Which DPC Program is your child involved in?

Creche (under school age)

Little Kids Church (3 yrs - Prep)

Kids Church (Prep - Gr 6)

Youth (Gr 7 - 12)

Parent/Guardian Information

Parent/Guardian Name (First & Last Name) *

Parent/Guardian Phone Number *

Parent/Gurardian Email

Care Information For Your Child

If your child has an allergy, please note how severe it is (eg. needs an epi pen). Please also send a copy of the allergy action plan to emily@dpc.cc or bring it into Church/Youth.

Child Medical Note 1 - Critical issues

Child Medical Note 2 - Allergies & Intolerances

Child Medical Note 3 - Other health/behaviour issues

Is the child subject to a custody order? (If so, please provide details to the Coordinator or Pastor)

Emergency Contacts

Child Emergency Contact & Relationship *

Child Emergency Phone Number *

Permissions

Photography Approved for the Child *

Transport Approved for the Child

Communications & Social Media Approved for the Child *

Privacy Declaration

I understand that by submitting this form I give permission for the personal details given herein to be provided to appropriate leaders &/or relevant medical/emergency services as deemed necessary. I understand the details given herein will be used by leaders to contact myself &/or my child/ren & that the details will not be given to any third party, except as provided above.

Authorisations & Expectations

By completing & submitting this form, I hereby give permission for my child to attend all scheduled activities this year, unless we explicitly advise the leadership team otherwise. In doing so I undertake to provide the leaders with any information relevant to the wellbeing of my child prior to them attending any & all scheduled activities. I understand that every effort will be made to provide a safe environment, however, by submitting this form I authorise the leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue or other services considered necessary. I also acknowledge that being part of a community involves mutual care & consideration, & therefore agree that unacceptable behaviour may result in my child being sent home &/or being temporarily or permanently prohibited from attending the activities of this group.