KFJ Registration Form

Kids for Jesus (KFJ) Sunday School Registration Form

Holy Trinity Anglican Church Wentworth Falls

A Parent or Guardian needs to complete this form. Thank you for filling out this form.

Health information and some family details can be sensitive and will be kept confidential.

Please talk to your child’s class teacher if any questions.

Please complete one form for each child being registered.

Details of Child

First Name *

Last Name *

Date of Birth *

Gender *

School Grade

Current School

Address where child resides

Home Address *

Home City *

Home State *

Home Post Code

Email Address

Tip: Parent's Email Address

Child's Health Information

Emergency Contact

Tip: if parents can't be reached

Relationship of Emergency Contact to child

Emergency Contact Number

Tip: No spaces, please

Please list any known allegies

Allergies

Is your child on a special diet, on any medication (not already noted), have a serious illness or disability, have a known behavioural problem or restricted from any activity? (Please note details and include a treatment/care plan if necessary)

Other Medical Information

Are there any access restrictions to your child?

Details of Parent/Guardian

Parent/Guardian Name *

Parent/Guardian email

Parent/Guardian Phone Number *

Parent Guardian Address (if different from child)

Authorities & Responsibilities

Kids for Jesus (Sunday School) Permissions *

I give permission for my child to be in KFJ group photos and appear in KFJ promotions

I do NOT give permission or my child to be in KFJ group photos and appear in KFJ promotions

Preschool Children Only: Should my child need to go the toilet during the program, I consent to a KFJ leader toileting them. (If you answer no we will come and get you to toilet your child in the event this happens).

I understand each parent comes to KFJ once each term as a helper (not teacher), and I'm available on this date next term: *

My child will do better if I help on a DIFFERENT class to the one they're in

Yes

Please Read the Following

Indicating yes on the drop down menu below indicates:

Whilst all reasonable care will be taken, I accept full responsibility for the welfare of my child.
In an emergency, I understand every effort will be made to contact myself or the emergency contact person.
I give permission for my child to receive appropriate medical aid if the need arises, and paramedic assistance in the case of an emergency.

Selecting Yes below certifies acceptance of all these conditions:

Permission Given

Date Registration Form Completed

The leadership team of Kids for Jesus will treat all the information contained confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. Please don’t hesitate to contact Zac with any queries in relation to this information.