Welcome Bay Kidz Club Registration Form

Child's Name *

First name

Last name

Date of Birth *

Gender *

Parent/Caregiver's Name *

Home Address *

Address line 1

Address line 2

Address line 3

Address line 4

Town/Suburb

City

Postcode/Zip

Mobile phone *

Other phone

Email address *

Medical needs *

Please specify whether your child has a medical condition or allergies that we should know about or any medication that your child would be taking during the hours of the program

Consent for photos & videos on Welcome Bay Kidz Club and Welcome Bay Baptist Church Facebook & Instagram pages *

Please write yes or no to show whether you give consent for photos or videos which has your child in them to be used on our public facebook & instagram pages

Consent for photos & videos on Welcome Bay Baptist Church website *

Please write yes or no to show whether you give consent for photos or videos which has your child in them to be used on our church website

Consent for personal details to be stored on WBBC secure database *

Please write yes or no to show whether you give consent for your personal contact details (mobile number, email, emergency contact) to be stored on WBBC database for emergencies

Other nominated person to pick up child *

Emergency Contact Name & Number *

NOTE: All children are to be dropped off and picked up at the Welcome Bay Baptist Church by the parent/caregiver or other nominated person.
The program runs from 3 - 4.30pm on a Friday afternoon.
Parents/caregivers contact details will be stored securely on one phone held by one leader for communication purposes.
You only need to register your child once for the program.

Permission *

Please tick to show that you give Welcome Bay Baptist Church permission to have your child in our program

Date *

Please show the date of completing this form