Family Rego Form

Family Contacts - Parent/Carer 1

Family Contacts - Parent/Carer 2

Family Details

Emergency Contact

Please provide details for someone outside your immediate family who we can contact if we cannot get in touch with you.

Additional People for Pick Up

Consent to Participate

As a parent or legal guardian, I consent to my child/ren taking part in regular Children's and/or Youth programs at Stromlo Christian Church. 

Consent for Medical Action

In the case of my child(ren) requiring medical treatment or in the case of a medical emergency, I consent to the Stromlo Christian Church Children and Youth leaders providing first aid treatment, following an emergency action plan if applicable. I authorise the leaders where it is impractical to communicate with me, to arrange them to receive such medical or surgical treatment as may be deemed necessary. I also undertake to pay any costs which may be incurred for the medical treatment, ambulance transport and drugs. 

Children