Waves and Ripples Registration Form 2024 • Richmond Anglican Church

Ripples & Waves Membership Form 2024

This form contains contact information and medical details for your child. It will take about 10 minutes to complete. Please complete one form for each child.

The Richmond Kids Club Leadership Team will treat all the information contained confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. Please don’t hesitate to contact us with any queries in relation to this information.

Please contact our staff via waves@richmondanglican.com.au or ripples@richmondanglican.com.au if there are any changes to this information.

For more information about our Children's Ministry programs at Richmond Anglican Church please see our website.

Child Details

First Name *

Last Name *

Gender

Date of Birth

School Grade in 2024 *

School

Home Address Line 1 *

Tip: This allows us to send mail with the term information.

Home Address Line 2

Home City *

Home State *

Mailing Postcode *

Does your child have any mental health conditions, disabilities, learning difficulties or behavioural challenges? Please provide details.

Medications

Allergies *

Special Dietary Requirements

Is there anyone who is legally restricted from seeing your child? *

If yes, please provide details

Is there any additional information we should know to provide the best care and support for your child?

Parent/Guardian Details

Parent First Name *

Parent Last Name *

Mobile Number *

Parent's Email *

2nd Parent First Name

2nd Parent Last Name

2nd Parent's Mobile

2nd Parent's Email

Emergency Contact

Please provide the details of an emergency contact for the youth in case the above parent or guardian cannot be reached.

Emergency Contact Name *

Emergency Contact Number *

Emergency Contact Relationship to Child *

Pick up Permissions

Is there anyone not listed above whom you allow to pick your child up from Ripples or Waves? This includes parents of other children attending if carpooling.

1st Person's Full Name

1st Person's Phone Number

1st Person's relationship to child

2nd Person's Full Name

2nd Person's Phone Number

2nd Person's relationship to child

3rd Person's Full Name

3rd Person's Phone Number

3rd Person's relationship to child

Permissions

I authorise the leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue or other services that are considered necessary for my child. *

Yes

I give permission for pictures and videos of my child participating in kids club activities to be shared on the private parent's Facebook group. *

Yes

No, please describe circumstances below

Comments:

I give permission for my child to attend all scheduled Ripples and/or Waves activities, unless I advise the leaders otherwise. *

Yes

No, please describe

Comments:

I give permission for Paracetamol to be administered, if required (with notice to a parent/guardian). *

Yes

I acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my child being sent home and being temporarily or permanently prohibited from attending. *

I understand

I declare myself to be the parent and/or guardian of the aforementioned youth and declare the details in this form to be true and correct for 2024.

Signed: *