Playgroup @ St Annes - Registration • St Anne's Anglican Church Ryde

Playgroup @ St Annes Registration Form

Please fill out this form to register your child for Playgroup @ St Annes. Please fill in one form per child. All information will be stored on our safe Elvanto Church Management system.

Payment details will be provided on the next screen after this form has been submitted.

Child's Information

Legal First Name *

Home Address *

Preferred First Name *

Suburb *

Last Name *

Home State *

Date of birth (dd/mm/yyyy) *

Home Postcode *

Gender

Main language spoken at home

Medical Information

Does your child have any allergies? *

No known allergies

Yes (has allergies)

Allergy type

Response plan for anaphylaxis

Tip: Does the child carry an epi-pen?

Is there anything that would be helpful for us to know in caring for your child? (special diets, chronic illness, impairments, behavioural issues etc) *

Yes

Please provide details:

Parent/Guardian Information

This is the main contact for all notices and communication regarding Playgroup @ St Annes.

Parent/Guardian Relationship to Child *

Parent/Guardian Full Name *

Parent/Guardian Phone Number *

Parent/Guardian Home Address *

Parent/Guardian Email Address *

Person primarily bringing the child to Playgroup @ St Annes

Full Name *

Relationship to Child *

Phone Number *

Email Address *

Permissions

Is anyone legally restricted from seeing your child?

Legal Access Restricted

Yes

Legal Access Restricted Details

In a medical emergency, I give my permission for a doctor chosen by St Annes Ryde Anglican Church to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand that every effort will be made to contact me prior to instituting such procedures.

I give permission in case of emergency *

Yes

Acceptance of Conditions

St Annes Ryde Anglican Church respects your privacy. When you provide us with personal information by participating in church events/activities, visiting a website or otherwise, you agree to personal information about you and your children (under 18 years old) being handled as set out in the policy (available on our website). The personal information in this form will be made available to the Playgroup @ St Annes leadership, and medical and emergency services if considered necessary.

By accepting these conditions and submitting this form I permit my child to participate fully in activities associated with Playgroup @ St Annes.
I consent to photographs being taken and used for promotional purposes. Where children's faces are identifiable in photographs, I understand that efforts will be made by Playgroup @ St Annes to conceal their identity.
I confirm that the information given in this form is correct, and will advise of any changes to this information to the St Annes office.

Yes, I accept these terms and conditions (type/write your full legal name)

Signature of parent/guardian (physical signature required)

Date signed (handwritten date required)

Tip: (This form will be printed for you to sign on the day)