Youth Rego 2026

Child's Name *

Last Name *

Date of Birth *

Gender *

School Year

School

Adult 1 Name *

Adult 1 Phone Number *

Adult 1 Email *

Adult 2 Name

Adult 2 Phone Number

Adult 2 Email

Emergency Contact Name *

Tip: (Someone different from adult 1 or adult 2)

Emergency Contact Phone Number *

Child Email

Mailing Address

Mailing City

Mailing State

Mailing Postcode

Allergies/Medical Condition/Medication(s) Required *

I give permission for my child to recieve panadol when a leader with first aid training deems it necessary? *

Yes

‘Images’ (photographs and/or video recordings) may be used for general purposes within this program and the church community. All images will be stored securely and used only as stated.

Children’s full names will not be used with images unless further parent / carer consent is obtained. If circumstances change, parents / carers can inform us of their wish to withdraw this consent.

We will then seek to remove the child’s image where it appears in digital formats but may not be able to retract printed material. Individuals may also request specific images be removed.

I understand the information above and consent to my child's image being used as indicated: *

Internally - accessible to the church community only.

Externally - used in material available to the public for advertising the activities of the youth group.

None

I give permission for my child to travel home independently (e.g. walk / public transport) *

Yes

I give permission for my child to be driven by fully licensed leaders of NR youth (with other NR youth leaders/youth present in the vehicle) where travel may be involved for an activity or necessary for an emergency. *

Yes

I give permission for the following persons other than parents / carers to pick up my child from this program, as per a personal arrangement:

Transport 1 Name

Transport 1 Phone Number

Transport 2 Name

Transport 2 Phone Number

PRIVACY
Personal information collected is used only for purposes relating to the spiritual, pastoral, social, educational, administrative, legal and historical functions of the Church subject to the Church‘s Privacy Policy in accordance with the Privacy Amendment (Private Sector) Act 2000. Your acceptance of this written advice will be regarded as your consent to collect and so use the information as described. If you do not consent please advise immediately. A copy of the Church‘s Privacy Policy is available on the PCNSW website or upon request. Personal information will not be used for any other purpose without first obtaining your consent.

All the information on this form is correct and I give permission for my child to participate fully in the activities associated with this youth group - supervised by approved youth group leaders. *

Parent/Carer Initials and Date *