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Vertical Intermediates 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
*
Preferred contact method
*
Please specify how you would prefer to be contacted: call, text or email
Email
Text
Letter
Phone
Facebook
Slack
Cell
Medical needs
*
Please specify whether your young person 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 the Vertical 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 young person 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 young person 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 young person
*
Emergency Contact Name & Number
*
NOTE: All young people 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 6-7:30pm on a Friday evening.
Parents/caregivers contact details will be stored securely on one phone held by one leader for communication purposes.
You only need to register once for the program.
Permission
*
Please tick to show that you give Welcome Bay Baptist Church permission to have your young person in our program
Special offsite events
*
Please tick to acknowledge that we may plan to run special offsite events (eg. trip to the hot pools, Tye Park, bowling) throughout the year. Whenever this is planned, we will always communicate this with you ahead of time and require written and/or verbal permission before the young people goes offsite from the Welcome Bay Baptist Church.
Date
*
Please show the date of completing this form
Please check the highlighted fields
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