EAST REV 2025 - ANNUAL CONSENT FORM • unihill church

Unihill East REV Youth Annual Registration Form 2025

Parent/Guardian Details

Parent/Guardian Name 1

Family Name

Relationship to Child

Mobile Number

Email Address

Address

Suburb

Postcode

Parent/Guardian Name 2

Family Name

Relationship to Child

Mobile Number

Email Address (leave blank if same)

Address (leave blank if same)

Suburb (leave blank if same)

Postcode (leave blank if same)

Children's Details

CHILD DETAILS

Name *

Date of Birth

School Grade *

Mobile (Only need to provide if wanting to join WhatsApp group. There will be no direct private contact between Youth and Leaders)

Medical Authorisation

Should I/we be unavailable in the case of an emergency involving my/our child. I/We hereby authorise UniHill Leaders to arrange for such Medical or Surgical treatment, and the administration of medication such as analgesics, as may be deemed necessary. I/We indemnify UniHill Church against all cost arising from such action, including Ambulance charges.

Yes

Ambulance Membership Number

Does your child have any allergic reaction to any type of drug, food, pollen, animal or anaesthetic?

Yes

Anaphylaxis

Yes

What is your child allergic to? Details:

Please detail any further dietary requirements

Medical conditions (Please select all that apply)

Please indicate below any Intervention/Extra Care/Response Plan/Special Requirements. Please note: We also require a copy of any anaphylaxis and asthma plans to be presented, either in a hard copy or to be e-mailed to n.mann@unihillchurch.com.au

Emergency Contact

Preferred Name

Relationship to child

Phone Number

The Agreement

The information provided on this form is correct and I accept it is my responsibility to inform the REV Youth Department should any changes occur.

Yes

I accept that program staff will maintain appropriate standard of supervision and safety, but that the program accepts no responsibility for accident, illness or damage to property due to any program activities.

Yes

I further authorise Uni Hill staff to act on my behalf, where I cannot be contacted, to obtain any ambulance service that my children may require and agree to meet any expenses attached to this service.

Yes

In case of emergency, where I cannot be contacted, I agree to my children being transported by private vehicle.

Yes

Are there any other issues we need to be aware of? Eg. Custody or restriction orders? If YES please provide details:

I give permission for Unihill Church to use my contact information provided in this form to inform me of church events via e-mail and text message. Please note, you can unsubscribe from our mailing list at any time.

Yes

Photo Consent

Do you give permission for photos to be taken/used of your child during the event?

Yes

Driving Consent

I give permission for my child to be driven by a UniHill screened licensed driver. REV Youth will always communicate if there is any travelling at a youth event. This generally occurs about 4 times each year.

Yes

Please note: all information gathered from you will be used in accordance with our privacy policy. Our privacy policy can be found here.

Parent / Guardian Acknowledgement

Your Name

Date

Click the 'Add Another Child' button below to add more children.

There is no need to include Parent/Emergency contact details again if they are the same.