Next Gen Registration - Youth '22,23 • Glen Waverley Anglican Church

NEXT GEN MINISTRY REGISTRATION FORM

This form is intended to assist leaders in case of any medical emergency during the course of participating in any NextGen Ministry activity. Please complete fully, including the details of all who hold legal custody over the child, and return as soon as possible, prior to your child's involvement in the ministry activity.

This form is to be filled in by a parent or guardian of the participant.

Child details

First Name

Preferred Name

School Grade

Email Address

Last Name

Gender

Date of Birth

Home Address

Home State

Mailing Address - If different to home address above

Mailing State

Home City

Home Postcode

Mailing City

Mailing Postcode

Are there any custody arrangements regarding your child?

Extra info about custardy arrangements.

Parent or Guardian Details - 1

First Name

Phone Number

Address: If different to child's

What is your relationship to the young person

Last name

Mobile Number

Email Address

Names of others who are likely to pick up your child.

Parent or Guardian Details - 2

First Name

Phone number

Last name

Address: If different to child's.

Emergency Contact

First Name

Phone number

Are they authorised to collect?

Last Name

Relationship to young person

Medical infomation

Name of family Doctor/ Clinic

Medicare number

Hospital/ medical fund name

Are you an ambulance subscriber?

Are there any medical conditions that we should be aware of?

Does your child carry any medication with them?

Who is to administer the young persons medication?

Does your child have any special food requirements? If so, please provide details.

Does your child have any allergies?

Medical clinic phone number

Health Care Number

Health Fund Number

Ambulance subscription number

Please give more details about medical conditions, if necessary.

Tip: Eg. Do they have a management plan?

Please give more details about medications, if necessary.

Permissions

By checking these boxes below, I acknowledge that:

Permissions:

I give consent for photographs and video footage of my child during activities and am willing for my child to be so filmed in appropriate settings and for these photos or footage to be used to promote the ministry in a way that does not identify their name or details. My child is also willing for this to take place.

• I consent to my child’s/youth’s participation in online children’s/youth group activities using social media platforms, including platforms like Zoom, YouTube, Facebook, Discord, messaging services, emails etc. (Please be aware that some of these platforms require individuals to be 13 years of age). I understand there will always be at least two adults from the recognised church/parish youth/children’s ministry in attendance. It is my understanding that there will be NO one-on-one online communication in this arrangement.

I give permission for my child to be transported in private cars arranged by the leaders as necessary for the program.

I authorise the leader/s in charge of any activity conducted by GWAC (Glen Waverley Anglican Church) to consent on my behalf, where it is impractical to communicate with me, for my child to receive medical or surgical treatment as may be deemed necessary. I am also responsible for the cost of any medical treatment deemed necessary.

Confirmation:

By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. the electronic signature will be equally as binding as an original manual paper signature.

Name of Signature:

Date of Signature.