Calvary Youth Child Information Form
First Name
*
Last Name
*
Date of Birth
*
Gender
*
Male
Female
Email Address
*
Mobile Number
School/College/University Name
*
School Grade
*
-- None --
Prep
1
2
3
4
5
6
7
8
9
10
11
12
University/TAFE
N/A
Home Address
*
Home City
*
Home State
*
Home Postcode
*
Emergency Contacts - Parents, Guardians or Carer
Emergency Contact Name
*
Emergency Contact Phone
*
Emergency Contact Email
*
Health & Wellbeing
Child's Swimming Ability
*
Can't Swim
Sound Swimmer
Excellent Swimmer
Known Medical Conditions
*
Tip: -Please include Asthma. -If not applicable, please at N/A
Required Medication
Allergies (Provide Details)
Dietary Requirements
Medicare Card
Permissions
Permission to use photograph in advertising/social media
*
Yes
No
Do you give permission for your child to be provided medical treatment by a First Aid officer where required?
Yes
No
Do you give permission for your child to travel in a Leader Vehicle for youth events?
Yes
No
Declaration
I, (Insert Name) being the Parent / Guardian / Carer of the above child;
*
Give permission to attend Calvary Youth and declare that to the best of my knowledge the information provided on this form is true and accurate.
*
True & Accurate
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