Lifegate Kids Registration Form

Locations *

Lifegate Padstow

Lifegate Prestons

Lifegate Online

Zoom

Kid's Ministry Group attending: *

Child's details

Last Name *

Name: *

Gender *

Child's Date of Birth:

Age:

Current year at school (if applicable)

Parent/Guardian Information:

Preferred Contact:

Relationship to child: *

Name: *

Mobile Number: *

Email address: *

Medical:

I understand that if urgent medical attention is needed, that every effort will be made to contact the persons listed on this form. In the event that I cannot be contacted in an emergency, I give my permission for my child to receive necessary medical treatment.

First Aid *

Urgent Medical attention *

Allergies *

Medical Condition (including asthma): *

If yes to any of the above, please provide details including medical treatment necessary.

Emergency Contact

In case of emergency and the Parent/Guardian is unable to be contacted, please provide an emergency contacts different to those above.

1. Name: *

Contact Number: *

Permission and Indemnity Section

Please read the following points and select your response for each section.

Information and Media

Photographs or video footage that may be taken of my child can be used or shown as the Lifegate Church see fit. *

Child pick-up

Name of any person NOT permitted to contact or collect the child during the program:

Name:

Relationship to child:

Please give details of any Court Order relevant to the previous two sections:

Parent/Guardian's signature:

By submitting this form, I agree that the information supplied has been completed truthfully and to the best of my knowledge. I also understand that Lifegate Church will keep these records on file for ministry purposes only.

Lifegate Church is a Christian Church where we teach on finding Freedom and Purpose through Jesus. Kids Ministry will include teaching times where we will introduce your child to Jesus.

Date of permission given *

Note: when Lifegate is mentioned within this document it covers all Lifegate Campuses.

Kathryn Reed

Kids Pastor

Lifegate Church

P: 02 9772 2537

W: www.lifegate.org.au