Junior Jivers Registration • Lighthouse Church

Parent Details

First Name *

Last Name *

Date of Birth *

Mobile Number *

Email Address *

Home Address *

Home City *

Home Post Code *

How did you hear about Junior Jivers? *

Invited by

Do you attend a church regularly? *

What other church do you attend?

Health Information

At Junior Jiver’s the responsibility is for parents to bring morning tea for their own children. On rare occasions (eg birthdays) parents bring extra food to share with other kids.

Do you acknowledge responsibility for your child’s health/safety regarding allergies and to advise of allergies at the time of food being given to kids?

Allergy Consent *

I agree

Occasionally photos/videos may be taken during Junior Jivers for the purpose of advertising and sharing how fun the mornings are. If you consent for your family to be photographed or videoed, please indicate below.

Photo/Video *

I give consent

I DO NOT give consent

Junior Jivers has a What'sApp group where regular messages are sent out about the program and where you can ask questions if you have any.

I would like to be added to the Junior Jivers WhatsApp group *

Yes

Children

Please provide the names of the children in your care at Junior Jivers

Child 1

Child 2

Child 3

Child 4

Child 5

Child 1 Date of Birth

Child 2 Date of Birth

Child 3 Date of Birth

Child 4 Date of Birth

Child 5 Date of Birth