DPC PresSafe Enduring Permission Kids and Youth
Child Information
First Name
*
Preferred Name
Last Name
*
Gender
Male
Female
Date of Birth
*
Mobile Number
Email Address
Home Address
*
Home Address Line 2
Home Suburb
Home State
Home Post Code
School
School Grade
*
-- None --
Kindy
Prep
1
2
3
4
5
6
7
8
9
10
11
12
Does your child attend church anywhere?
No
Dalby Presbyterian
Dalby Anglican
Dalby Baptist
Dalby Christian Family
Dalby Church of Christ
Dalby Lutheran
Dalby Uniting
Other
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
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)
No
Yes
Emergency Contacts
Child Emergency Contact & Relationship
*
Child Emergency Phone Number
*
Permissions
Photography Approved for the Child
*
Photograph and publish (inc church website and social media)
Photograph and share on closed social media
Photograph and display in church
Do not photograph or publish images
Transport Approved for the Child
Travel with a open-licensed leader driving the vehicle
Travel with provisional license holder (leader in vehicle)
Communications & Social Media Approved for the Child
*
Email
SMS / Text Messaging
Phone call
Social Media (eg Facebook)
Video call
Contact through parent only
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.
Submit