180 Registration form 2024 • St David's Anglican Forestville

Registration

Thanks for taking the time to register and pay for 180 for this term.

Choose Event

Child's Information

First Name *

Surname *

Gender *

Date of Birth *

School *

School Grade *

Home Address *

Home City *

Home Postcode *

Email Address

Medical & Behavioural Information

Allergies *

Does your child have any known behavioural conditions that would be helpful for us to know about? *

Please provide detailed information regarding any other medical information.

Parent/Guardian Information

Primary Contact

This is the main contact in case of emergency as well as for communication regarding your child.

Parent/Guardian Full name *

Parent/Guardian Phone number *

Parent/Guardian email *

Parent/Guardian Home address *

Secondary contact

This must be different to the Primary Contact. This secondary contact should be an adult relative or friend who is easily contactable in case of emergency when the Primary Contact is unable to be contacted.

Secondary Contact Full Name *

Secondary Contact Phone number *

Permissions

I give permission for my child to appear in photos and/or videos that may be used for St David's promotions, both online or in print. *

There may be times in our Kids and Youth activities when we view films, television shows or footage from those media. Generally, these are G rated. However, sometimes we may consider showing short, relevant and appropriate excerpts of PG rathed films, TV shows or footage.

I give permission for my child to participate in all children's or Youth activities associated with St David's Anglican Church. *

In case of a medical emergency, I hereby give permission to the Doctor chosen by the church authorities or other persons supervising or administering the children's activity, to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand that every effort will be made to contact me prior to instituting such procedures.

Permission for hospitalisation, injection, anaesthetic or surgery *

Cost

The cost of 180 is $15 per child for the whole term.

Payment can be made by credit card payment HERE