Southern Kids - Primary School Registration • Southern Christian Church

This form is for anyone who is planning to come to Southern Christian Church's 10am service at the Cockburn Youth Centre, and plans to leave their kids in our primary-school aged program for the first time. Hard copy registration forms can be completed at church on the day, but if you prefer to have everything organised before you arrive, then this is the form for you!

More information about Southern Kids can be found at https://www.southern.org.au/southern-kids.

Parent / guardian details

First Name

Last Name

Relationship to child

Phone Number

Email Address

Home Address

Would you like to receive Southern Christian Church's weekly email notices? This is one of the best ways of finding out what's happening in the life of the church.

Yes please!

No thanks!

Are you the parent / legal guardian of the child being registered?

Yes

If not, has the child's parent or legal guardian given consent to their child participating in Southern Kids primary school aged program?

Yes

Parent / guardian's name

Parent / guardian's phone number

Child's details

Child's name

Date of Birth

Does your child have allergies / asthma? (If yes, give details)

Do you give permission for minor first aid to be administered during the service (e.g. band-aid for graze). Note that if any first aid needs to be administered where a trained First Aider is required, we will only ask the church First Aider to administer

Yes

Do you give permission for photos of your child to be used in our online or printed media? (e.g. website, social media)

Yes

Yes, only if the face is not visible

Is your child able to use the toilet by themselves, and do you consent for them to do so? If consent is not provided, we will contact you via SMS during the service and ask you to take your child to the toilet. Please take your child to the toilet before

Yes

Any other medical information / special needs?

By submitting this form, you affirm that you are the adult named in this form. By submitting, you provide consent for the child named in this form to be left with the Southern Kids volunteers during the service. You agree to comply with the parent’s responsibilities as outlined in the Southern Kids primary school procedure at https://www.southern.org.au/southern-kids.