Kids Ministry Registration Form

Child/ Young Person's First Name *

Child/ Young Person's Last Name *

Date of Birth *

Gender

School Grade *

Parent/Carer's Name *

Parent/Carer Phone Number *

Parent/Carer Email Address *

Address

City

State

Postcode

Medical Information

Are there any allergies, dietary requirements, physical needs or medical issues we should be aware of? *

Tip: If yes, please provide further details/action plan.

If you have an action plan for management of anaphylaxis, asthma or any other condition please provide a copy via email to mbc@mayfieldbaptist.com so that leaders can be made aware of it.

Food Intolerances

Allergies

Medical issues/physical needs to be aware of

Emergency Contact Information

Alternative contact details in case we are not able to contact you in an emergency (Please inform this person that you have submitted their details)

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship to the child/ young person

Permissions Given

Do you give permission for your child/ young person (named above) to attend Mayfield Kids?

Consent for details to be stored by the church *

Consent Parent/Carer to be contacted by group leaders or the church office by: *

Phone

SMS

None

Photography and Video

On occasion, photos or videos may be taken by leaders to capture events. The photos may be used for things such as digital or physical displays, the church website, the church, and/or the youth group's social media profiles. We respect the privacy of our young people, so if you wish for your child or young person not to be photographed in this way please let us know below.

Image Use

External Use Not Allowed

Internal Use Not Allowed

Permission given by: *

Relationship to the Child/ Young Person *

Information Form Signed on: *

Tip: By completing this section you agree the above information is true and correct. (Year in which the form is signed is the year student is registered for).

Thank you for providing this important information. We will store your details in accordance with the Recordkeeping section of our Safe Church Policy which can be found on our website along with our other Policies and Procedures: https://www.mayfieldbaptist.com/safe-church