Impact Youth Group Permission Form

Impact is a Christian Youth Group which gathers for students in year 6-12 (or equivalent) on Friday nights during the school term from 7pm-8:45pm at Sans Souci Anglican Church, Corner Rocky Pt Rd and Rawson St. As Christians, it is our strong desire to provide a safe, friendly and welcoming environment to your children. As part of this commitment to safety, we kindly ask you for the following details as well as your permission for your youth to join us each week.

Parent / Care-giver

First Name *

Last Name *

Phone Number

Mobile Number *

Email Address *

Home Address *

Home City *

Home Postcode *

Parent / Care-giver (only include details that differs from above)

First Name

Last Name

Phone Number

Mobile Number

Email Address

Home Address

Home City

Home Postcode

Emergency Contact (alternative to parent/caregiver)

Name *

Relationship to child/ren *

Home Phone

Mobile *

Privacy Declaration
Sans Souci Anglican Church is exempt from the requirements of the Privacy Act 1988 (Cth) as it is a small business. However, we seek to deal carefully with the personal information we collect and to do so in a manner consistent with your reasonable expectations.
The personal information in this form will be made available to
(a) the leaders involved in the running of the activities in which my child participates, and
(b) medical and emergency services if considered necessary.

Authorisations & Expectations

I give permission for my child to attend all scheduled Impact activities, including online meetings via zoom and other relevant technologies, unless I advise the Impact leaders otherwise.
I authorise the Impact leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue or other services that are considered necessary for my child.
I acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my child being sent home and being temporarily or permanently prohibited from attending the activities of Impact.
I will provide the Impact leaders with any information relevant to the wellbeing of my child prior to him or her attending an Impact activity.
I give permission for my child to travel in a car driven by an approved Impact leader or a parent approved by an Impact leader unless I advise the Impact leaders otherwise. (Your child will not be in a car driven by a learner or provisional licence holder).

I agree to the above authorisations and expectations *

I agree

I give permission for photos/videos of my child taken at events to be displayed publicly (online and in print) unless I advise the leaders otherwise. *

Agree

Disagree

Youth - Personal Details

Name *

School *

Medicare Expiry Date *

Position on card *

Medicare Number *

Ambulance Cover *

Gender

Date of Birth *

School Grade *

Mobile

We will keep these details on file so that we do not have to ask for them prior to each event, unless you request otherwise. Please advise Impact as soon as practical of any changes to this information.

Authorisations

Do you authorise your child to make their own way to and from Impact events? *

How would you like us to communicate events/news with you and your child? *

Medical and care needs

Does your child have any medical conditions that we should know about? (i.e. prescription medicines, chronic illness, medical allergies, etc) *

Do you give permission for your child to take paracetamol if required? *

Does your child have any care needs that we should know about? (i.e. behavioural concerns, psychiatric care, etc) *

Is there anyone who is legally restricted from seeing your child? *

Please indicate who this is:

Does your child have any special dietary need that we should know about? (e.g. food allergies, intolerances, etc) *

Is your child capable of swimming more than 30m unassisted? *

Please provide further details to above answers as required