St Mark's Events Registration Form

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So we can look after students in the best possible way, we need information. We commit to keeping this information private. We will only use it to ensure the safety and well being of students while involved with St Mark's events.

Student Name *

Which event/s will the student be attending? *

Kids Zone

Holiday Fun Time (Prep - grade 6)

C.H.A.O.S. (grade 7 - grade 12)

Confirmation

Other:

Required

Student's School

Student's School Year

Student's Date of Birth *

YYYY

Student's Gender *

Male

Female

Other:

Student Email

Student Mobile

Student's Full Address

Parent's/Guardian Name *

Parent's/Guardian Mobile *

Parent's/Guardian Email *

Emergency Contact Name *

Emergency Contact Phone Number *

Medical Conditions/Needs *

Food Allergies *

Other Important Details We Should Know

Parental/Guardian Consent *

I consent to this information being stored by St Mark's Church. It will be used only for St Mark's Ministries in accordance with the LCAQD Privacy policy.

I agree that in the event of a medical emergency where I cannot be contacted that leaders will arrange the best possible medical care. I agree to pay in full for all medical costs involved. I will not hold St Mark's Church or it's agents for any loss or injury occurred. (REQRD)

I consent to the use of photos of my student for promotional purposes within St Mark's Church (optional)

I consent to my student being transported by a fully licensed leader (only in case of a medical incident) (optional)

Required

Parental/Guardian Signature (Print name in CAPS) *

Parental/Guardian Date of Signature *

YYYY

Student Behaviour Commitment *

I will respect people and help everyone have a good, safe and fun time.

If I am disrespectful or make people feel unsafe then I may not be allowed to participate in activities, my parents may be phoned and asked to pick me up.

I understand the St Mark's events are completely drug and alcohol free.

Required

Parent Signature on behalf of Student (Print name in CAPS)

If my child is under the age of 18, I have discussed the Student Behaviour Commitment with them and signed on their behalf

Date of Signature *

YYYY

St Mark's Lutheran Church gathers and stores the following information: Names, Addresses, Phone Numbers and Emails. This information is stored only for the purpose of communication with and care for our Church community. No personal details are given out to anyone not in this contact list. Details will not be published or made available anywhere else without prior consent. If you have any questions about our privacy policy or wish to be removed from the list, please contact St Mark's Church office.

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