Cooee Playgroup Term 2 2024 Friday Group • unihill church

2024 Term 2 FRI Cooee Playgroup 9:30am Box Hill 0

Protecting your privacy is important to us. The information we seek allows us to manage risk and provide appropriate care for your child.

We are careful to keep your information confidential. These details are only shared with those in leadership and stored in a secure location. You are welcome to contact our office in relation to issues regarding your personal information and for a copy of our Privacy Policy.

Family Details / Enrolling Adult

Last Name *

First Name *

Mailing Address *

Email Address *

Mobile Number *

Emergency Contact

Name *

Relationship

Mobile Number *

Children's Details

Child 1 Name *

Date of Birth *

Child 1 Medical Conditions / Special Care required / Allergies (noting reaction and intervention required).

Does your child have any extra care needs? If so, please indicate briefly below:

Child 2 Name

Date of Birth

Child 2 Medical Conditions / Allergies (noting reaction and intervention required).

Does your child have any extra care needs? If so, please indicate briefly below:

Child 3 Name

Date of Birth

Child 3 Medical Conditions / Allergies (noting reaction and intervention required).

Does your child have any extra care needs? If so, please indicate briefly below:

Other

Are there any other issues we need to be aware of? eg. Custody or restriction orders?

The Agreement

I am willing for my child/ren to participate in all activities offered in the program. I agree that it is my responsibility to familiarise myself with the program and to advise staff if I do not wish my child/ren to participate in an activity. *

Yes

I realise that it is my responsibility to inform the program if my child/ren contracts any illness that could be detrimental to the health of others at the program. *

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

In the event of an accident or illness associated with my child/ren, I give permission for the required emergency medical assistance to be given to my child/ren on my behalf and agree to meet any expenses associated with that medical assistance. *

Yes

I further authorise UniHill staff to act on my behalf, where I cannot be contacted, to obtain any ambulance service that my child/ren 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 child/ren being transported by private vehicle. *

Yes

Photo Consent

Please Note: During our events your child may be photographed, or video footage taken for internal promotional and display purposes. It is a condition of entry that each member waives any claim they might have in relation to inclusion of their likeness in such films or recordings. We have a nominated photographer and images are stored in one location for internal promotion only.

I give permission for Cooee Playgroup to use photographs or other media images its representative has taken of my child, with or without others, whole or in part, for internal promotion and display purposes. *

Yes

I understand that Cooee Playgroup will occasionally want to use images for external promotion and I give permission for this. If my child is selected for this purpose I understand I will be contacted, and I further understand that the images may be altered *

Yes

If I take photographs during a playgroup session, the focus will be on my child. *

Yes

I understand that other carers may take photographs of their child/ren and my child will not be the focus but may appear in the background of those photos.

Yes

Signature

Your Name *

Date