Kids Reach 2024 • Green Pastures Church

First Name

Last Name

Gender

Date of Birth

Primary School Attended

School Grade

Doctor's name and surgery

Home Address

Town

Medical Conditions/ allergies/additional info

Parent/Guardian Name

Mobile Number

Emergency Contact name

Contact Number

In order to ensure the safety of your child(ren) while in our care, we require your consent for the following:

Permission for your child(ren) to take part in the normal activities of this department which includes the use of GP Kids Playground and all the equipment in this space
In the event of illness or accident, permission for the application of medical or first aid by appropriate persons.
In the event of your child(ren) needing emergency hospital treatment, we will endeavour to contact you immediately.
If using church transport, permission for transporting uyour childrenat the appropriate time
permission for photographs or videos of your children to be taken for church use including social media

Consent given by by parent/guardian signature

Date