Kids Bible Program Registration - Westminster Presbyterian Church Bull Creek

Kids Bible Program is an activity of the Westminster Presbyterian Church Bull Creek. The activities include but are not limited to: Bible study & activities.

Childs First Name *

Child's Last Name *

Date of Birth *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Year at School *

Emergency Medical Details

Does your child have any medical conditions that we should be aware of? *

Yes
No

Please list medical condition/s

Emergency Contact Information

Emergency Contact Number *

Alternative Emergency Contact Number *

Parent's Email *

Parent's Mobile Number *

Parent/Guardian Name *

Parent/Guardian Signature *

In signing this permission slip, I authorise WPC Bull Creek Bible Program leaders/volunteers in charge, where it is impractical to communicate with my child/ward or me, to arrange for medical treatment for my child/ward as deemed necessary by a qualified medical practitioner. I agree that the information given by me in this form is current, true and correct. I certify that the particulars given above are current, true and correct.

Date *

I consent that Kids Bible Program may use photos and/or video footage of me/my child for website/newsletter/other publication purposes *

Yes
No

In my child attending the Kids Bible Program

I authorise Kids Bible Program, where it is impractical to communicate with me, to arrange emergency medical treatment for my child

I authorise the use of ambulance for my child should it be deemed necessary and authorise the use of anesthetics by a qualified medical practitioner if in his/her judgment it is deemed necessary

I agree that I /my child will abide by the rules, guidelines and instructions by Kids Bible Program

I accept all forseeable risks associated with my child participating in Kids Bible Program activities

I agree that I will be responsible for any costs incurred on behalf of me/my child due to a medical emergency, accident or misdemeanor whilst attending Kids Bible Program activities