Rise Youth Annual Child Attendance Form
Email *
Family Name: *
1st Children's / young person's name *
2nd Children's / young person's name
3rd Children's / young person's name
4th Children's / young person's name
1st child Date of birth (each child) *
2nd child Date of birth (each child)
MM
/
DD
/
YYYY
3rd child Date of birth (each child)
MM
/
DD
/
YYYY
4th child Date of birth (each child)
MM
/
DD
/
YYYY
Parents / caregivers name *
Parents contact details (phone number, email, family address *
does your child/ children have any: *
please write any of the above if selected
is your child/ children allowed paracetamol *
1st child medicare number *
2nd child medicare number
3rd child medicare number
4th child medicare number
 *
emergency contact (name and phone number)
Do you consent for your child to participate in activities at new heights Christian church/ rise youth where incidental activities may arise, I agree to delegate my authority to the designated leaders involved and to entrust them with the safety and well-being of my child / children / young person as a group and individually *
Do you give permission for NHCC / rise youth to publish photos of your child?
Clear selection
Name of person filling this form out *
A copy of your responses will be emailed to .
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