PBC CHILDREN'S PROGRAMMES REGISTRATION FORM

Child's Information

Please fill in the following information for each of your children :

Question Title

* 1. Child 1 :

Full Name

Boy / Girl

Birth Date (incl. year please)

School Year or N/A

School or N/A

Current Sunday Programme*

*Ark (18mth - 3.5 yrs) Nest (3.5 yrs - 5 yrs) Lighthouse (6 yrs - yr 6) Tribe (Intermediate)

Question Title

* 2. Child 2 :

Full Name

Boy / Girl

Birth Date (incl. year please)

School Year or N/A

School or N/A

Current Sunday Programme*

*Ark (18mth - 3.5 yrs) Nest (3.5 yrs - 5 yrs) Lighthouse (6 yrs - yr 6) Tribe (Intermediate)

Question Title

* 3. Child 3 :

Full Name

Boy / Girl

Birth Date (incl. year please)

School Year or N/A

School or N/A

Current Sunday Programme*

*Ark (18mth - 3.5 yrs) Nest (3.5 yrs - 5 yrs) Lighthouse (6 yrs - yr 6) Tribe (Intermediate)

Question Title

* 4. Child 4 :

Full Name

Boy / Girl

Birth Date (incl. year please)

School Year or N/A

School or N/A

Current Sunday Programme*

*Ark (18mth - 3.5 yrs) Nest (3.5 yrs - 5 yrs) Lighthouse (6 yrs - yr 6) Tribe (Intermediate)

Question Title

* 5. Family Contact Details (Please complete even if we already have your info so we can check it is still correct)

Mum's Name and Cell

Dad's Name and Cell

Home Phone or N/A

Address

Name and Contact Number for Emergency

Question Title

* 6. Other Information

People authorised to collect your child/ren

Special Custody Arrangement

Any other information that may be relevant - eg. allergies, medical conditions, behavioural needs etc. Please specify which child :

Question Title

* 7. Ark and Nest Consent

	Yes	N/A
I give permission for my child/ren to be taken to the toilet by a leader if required	I give permission for my child/ren to be taken to the toilet by a leader if required Yes	I give permission for my child/ren to be taken to the toilet by a leader if required N/A
I understand that I may be required to change my own baby's/toddler's nappies	I understand that I may be required to change my own baby's/toddler's nappies Yes	I understand that I may be required to change my own baby's/toddler's nappies N/A
I understand that I need to provide morning tea for my child if they have special food requirements	I understand that I need to provide morning tea for my child if they have special food requirements Yes	I understand that I need to provide morning tea for my child if they have special food requirements N/A
I accept full responsibility for making sure my child/ren are collected from the programme by either myself or another designated adult.	I accept full responsibility for making sure my child/ren are collected from the programme by either myself or another designated adult. Yes	I accept full responsibility for making sure my child/ren are collected from the programme by either myself or another designated adult. N/A

Question Title

* 8. All Programmes Consent

	Yes	No	N/A
I give permission for my child/ren to be photographed/videoed and for any images to be used on the church website or other promotional material	I give permission for my child/ren to be photographed/videoed and for any images to be used on the church website or other promotional material Yes	I give permission for my child/ren to be photographed/videoed and for any images to be used on the church website or other promotional material No	I give permission for my child/ren to be photographed/videoed and for any images to be used on the church website or other promotional material N/A
I give permission for my child/ren to be taken to the park adjacent to the church from time to time during the programme	I give permission for my child/ren to be taken to the park adjacent to the church from time to time during the programme Yes	I give permission for my child/ren to be taken to the park adjacent to the church from time to time during the programme No	I give permission for my child/ren to be taken to the park adjacent to the church from time to time during the programme N/A
I give permission for my child as part of Tribe to be transported to venues other than PBC. (Drivers will have their full driver's licence).	I give permission for my child as part of Tribe to be transported to venues other than PBC. (Drivers will have their full driver's licence). Yes	I give permission for my child as part of Tribe to be transported to venues other than PBC. (Drivers will have their full driver's licence). No	I give permission for my child as part of Tribe to be transported to venues other than PBC. (Drivers will have their full driver's licence). N/A
I understand that children in the Lighthouse and Tribe programmes will be released at the end to make their own way back to church - unless I have made other arrangements with the leaders.	I understand that children in the Lighthouse and Tribe programmes will be released at the end to make their own way back to church - unless I have made other arrangements with the leaders. Yes	I understand that children in the Lighthouse and Tribe programmes will be released at the end to make their own way back to church - unless I have made other arrangements with the leaders. No	I understand that children in the Lighthouse and Tribe programmes will be released at the end to make their own way back to church - unless I have made other arrangements with the leaders. N/A

Question Title

* 9. Name of person signing this form

Full Name

Question Title

* 10. Signature

I understand that by ticking this box I am providing an electronic signature.

This information will be kept for the purpose of providing appropriate care for your child/ren, and to advise you of upcoming events. All information will be stored securely and will not be released to a third party without your permission.

Please notify us of any changes to this information. Thank you.