Kids Holiday Club, FULL rego - 2026 • Glen Waverley Anglican Church

Kids Holiday Club - FULL REGISTRATION FORM

This form is ESSENTIAL for attending our event. (You must register at least FOUR (4) days BEFORE).

It is intended to assist leaders in case of any medical emergency during the course of participating in any GWAC activity when parent/carers are not present. Please complete this ELECTRONICALLY in full, including the details of all who hold legal custody over the child.

Latest EVENT info: April 2026 Movie afternoon.

THURS 16th APR, 2:00 - 4:00pm

Location: 800 Waverley Rd, Glen Waverley, Vic, 3150

What to bring? (No devices please)

Invite a friend!

Any medications & snack if special dietary.

Drink bottle

Please complete 1 form PER Child who will be Dropped-off

A confirmation email will be sent to you before the event.

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

Child details

First Name

Preferred Name

School & Grade

Last Name

Date of Birth

Gender

Home Address

Home State

Home City

Home Postcode

Are there any custody arrangements regarding your child?

Extra info about custody arrangements.

Parent or Guardian Details - 1

First Name *

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 & authorised 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

Last Name

Relationship to young person

Medical infomation

Medicare number

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 allergies?

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

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:

IN-PERSON: I consent to my childs/youths participation in the activities of which I have received notification. I will encourage my child to participate and co-operate with the leaders and other participants.

PHOTOS: 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.

MEDICAL: 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.