Please complete a registration form for each child

Please provide the names of any adults (18 years or older) other than yourself who are authorised to sign your child in/out.
(A form will also be available during Holiday Club for additional authorised adults)

Does your child have any of the following? Please email copies of any relevant action plans/medical documents to josiah@eppingpresbyterian.org.au

Please provide a different person to yourself

Use of photos and videos for promotional purposes: I agree that photos and videos of my child taken at Epping Presbyterian Church may be used by the church for promotional purposes, such as on its website or denominational material (e.g. The Pulse magazine)

Use of photos and videos in social media: I agree that photos and videos of my child taken at Epping Presbyterian Church may be used by Epping Presbyterian Church in social media.

Authority for rendering medical assistance: In the unlikely case of illness or accident, I give permission for any appropriate first aid to be given by the nominated first-aider. In an emergency, and if I cannot be contacted, I am willing for my child to be given hospital treatment if necessary. I understand that every effort will be made to contact me as soon as possible.

Authority for administering paracetamol mixture / Panadol: I authorise the leaders of this program to administer one dose of paracetamol to my child as per the instructions on the medication. I understand that this authority is a guideline for administration of a specific dose. I understand that I will be contacted for my permission for each specific instance. I understand the potential risks and side effects of this medication for my child.

Communication from leaders: I consent to my child receiving a follow-up letter from the leaders of the program (by post).

Other information: Is there any other information about your child/ family that you would like the leaders to know to enable them to meet your childs needs?

I authorise the leaders of the Holiday Club, in the event of an emergency, to obtain at my expense any medical, ambulance or similar services considered necessary.
I accept that any unacceptable behaviour on the part of my child may result in my child being prohibited from attending this program.
I accept that any photos or videos taken during the program which includes my child may be used internally at EPC.
I understand that the information provided here will supersede information given in the past to EPC and will also be used in other children's programs my child participates in.
I agree that the information contained on this registration form is true and correct. I agree that I will ensure that any changes to this information are advised in writing as soon as possible.