Lighthouse Kids Rego • Lighthouse Church

CHILD'S DETAILS

Child’s First Name *

Last Name *

Date of Birth *

Gender *

School *

School Year *

Invited by/How you found out about Lighthouse Kids? *

What church do you regularly attend?

Other

PARENT/CARER CONTACT DETAILS

Parent/Carer Full Name *

Mobile Number *

Email Address

Home Address *

Suburb *

PARENT/CARER #2 CONTACT DETAILS

Parent/Carer #2 Full Name

Mobile Number

CHILD PICK UP

Child will be regularly dropped off and picked up by *

HEALTH INFO

Is there anyone legally restricted from seeing your child? *

If Yes, please provide details

Does your child have any allergies? *

Describe any allergies in full. eg food, environmental, etc. *

Severity of Allergy *

EPIPEN: Please notify leaders that your child has an EPIPEN and provide a copy of their Anaphylaxis Action Plan to be kept on file

Is there anything that would be helpful for us to know in caring for your child (e.g. disability, behavioural issues, etc)? *

Please describe what your child's needs are and how we can best care for them *

At Lighthouse Kids we take photos and videos for social media purposes. Please talk to Matt if you would like your child to not be included, or call 0434 037 571 *

I've read this

I authorise provision of first aid and/or medical treatment for my child if needed, and understand every effort will be made to contact me should this be necessary as soon as possible *

Yes