Chancellor Youth First Time Guest

This form ensures we have up to date information to allow us to best care for your child. Please fill in one per child.

Protecting your privacy is important to us. The information we seek allows us to manage risk, provide reasonable care and administer your involvement in our program. We are careful to keep your information confidential, and provide it only to those agents acting on behalf of the organisation who need it to enable them to perform their agreed activities (e.g. the First-Aider-In-Charge). You are welcome to contact our office in relation to issues regarding your personal information.

Participant Details

First Name *

Date of Birth *

School Grade *

Does this participant have a life-threatening Allergy?

Description of life-threatening allergy and management

Any other Allergies or Information we should know?

Last Name *

Participant Email (optional)

Participant Phone number (optional)

Family & Emergency Contact Details

Emergency Parent/Carer Contact

First and Last Name (EC1) *

Tip: Note this person becomes the main contact for this child as well.

Relationship (EC1) *

Tip: Mother, Father, Guardian, Aunty etc.

Phone Number (EC1) *

Email Address

Consents

Chancellor Youth Terms and Conditions

As a Parent / Guardian of the participant attending Chancellor Youth, I agree to the following Terms and Conditions as a condition of attending Chancellor Youth or related Chancellor Youth events. For more information about how we care for your child see our Church Safe Strategy.

First and Last Name (CYT&C) *

Signature (CYT&C) *

Tip: Entering your name will be considered your written signature.

Date (CYT&C) *

We may sometimes take photos at Chancellor Youth, primarily to be used internally for our programs. However we will occasionally take photos for promotional purposes or sharing with our youth via social media. I give permission for photos and video of my child/ren taken at Chancellor Youth events to be used for publicity such as church newsletters, church website, church Facebook accounts and other promotional activities. Note, names will not be used.

Photo Permission

Yes