Ministry Information Form Child/Young Person 2025 • Springwood Baptist Church

Please select which activity your child or young person will be attending

Last Name *

First Name *

Date of Birth *

School Grade *

Parent/Guardian/s Name *

Phone Number *

Email Address *

Dietary Restrictions

Dietary Restrictions- other

Medical Condition

Medical Condition other

Allergy

Allergy - other

Emergency Contact 1 - Please state name and contact number *

Emergency Contact 2 - Please state name and contact number *

I authorise the leader in charge to arrange for my child to receive such first aid and medical treatment as a trained first aid person may deem necessary. *

Yes

No

I authorise the use of calling an ambulance in an emergency. *

Yes

No

I accept responsibility for payment of all expenses associated with such treatment. *

Yes

No

I give permission for my child to participate in activities outside of the normal meeting complex where they are within reasonable walking distance.

Yes

No

I give permission for my child to be transported in private cars arranged by the leaders of the group.

Yes

No

I permit photos taken of my child to be displayed in church publications, e.g. website, newsletters, brochures, etc.

Yes

No

Transport authority: If I am unable to collect my child at the finishing time they may be transported home from the program with the following people:

By ticking this box you grant permission for the participant listed above to take part in Springwood Baptist Church activities *

Yes

I am the parent/guardian listed on this form. *

Yes

Date *

Medical, allegry and food information - Please list any medical conditions or allergies, and any medication or special care they required. If your child is anaphylactic to any substance please provide information regarding EpiPen and management plan *