PlayTime Enrolment Form • Wahroonga Anglican

Registration for Youth Church and Children's Activities at Wahroonga Anglican Churches

Please complete this form for each child you are registering

This information will be kept confidential and will only be used to assist the Youth and Children's leaders to ensure your childs well being. If you have any questions about how this information is used or kept, or our programs, please feel free to contact Tamar Pollard at tamar.pollard@wahroonga.church

Child's Details

First Name *

Date of Birth *

Address

Address Line 2

Suburb

Mailing Post Code

Last Name *

School Grade *

School Attended

Phone Number

Mobile Number

Parent/Guardian - Mother

Mother Name

Mother Email

Mother Phone

Parent/Guardian - Father

Father Name

Father Email

Father Phone

Other information required:

Does your child have a special needs you'd like us to know about (physical, mental, learning, emotional, or English as a 2nd language) or significant behavioural problems? *

Is there anything else that we should know about your child? *

Is this child on a special diet we should know about? *

Please describe in full any allergies (food, drug, environmental) your child has, and medication, if required:

Please detail any operations or serious illnesses below:

If your child is restricted from any activity, please note the restriction and specify the condition involved here:

Other information or Comments

Permissions

I give permission for photos and videos of my children to be used for internal church events like prayer nights, recap videos and other productions to show in church. *

Photos allowed

No photos to be used

Tip: This will be used only within the Church family, and will never be shared externally

I confirm that the information given in this form is true and correct, and will advise of any changes to this information.