MEDICAL TREATMENT CONSENT: I being the parent/guardian of the said child understand that whilst every precaution will be taken to ensure the good welfare and protection of my child, Journey Uniting Church, its staff and volunteers acting on its behalf are hereby released from any and all liability in the event of any accident or misfortune, damage or loss that may occur to the child and their property. I hereby give permission to the First Aid Staff to ensure proper treatment for my child. I understand that every effort will be made to contact me before instituting such procedures. I agree to pay all such doctor, ambulance and hospital fees incurred on behalf of my child. I have attached a list of any health information about my child that the First Aid Staff need to know. INVOLVEMENT CONSENT: I being the parent/guardian of the said child hereby give my consent that my son/daughter may participate in any activities they choose over the course of the Summer Camp. These can include a range of camp-specific and general recreational activities. If specific risk-related activities are to be included, the Camp Coordinator will inform you of these. During the camp we may provide the young people with the opportunity to watch movies or play video games that have a PG rating. Youth aged 15+ may have access to movies/video games rated 15+. PERMISSION TO BE PHOTOGRAPHED OR FILMED: I give my permission for my child to be photographed or videotaped. I understand that the image may be displayed for both commercial and promotional purposes, including but not limited to in the church publications, advertisements, resources, programs for broadcast or sale, church buildings or website. I am aware that The Journey Uniting Church is a Christian organisation and that God will be discussed at this event. *
Child's Details
Child's Name *
Child's Name
Date of Birth *
Date of Birth
Postal Address *
Postal Address
Dietary Requirements *
Do you have any dietary requirements? If yes, please specify below. We will endeavour to meet these, and will contact you if there are any issues.
Safety and Care Details
In the eveny of an emergency, please list the phone numbers of a parent, guardian, relative or friend of the child who can be contacted at any time during the camp.
First Contact's Name *
First Contact's Name
Second Contact's Name
Second Contact's Name
Are there any custody details the Journey Uniting Church needs to be aware of?
Medical Information
Medicare Expiry Date *
Medicare Expiry Date
Ambulance Cover *
Do you have ambulance cover?
Please note that it is our policy, that our First Aid Officer does not provide or administer any medications unless they are specified below.
Do you consent to your child being given Panadol at the discretion of the First Aid Officer if needed? *
Will your child need to take any medication (including inhalers)? *
In the case of prescription medication, the original bottle/container needs to be provided as the label with the Doctor's directions must be present.
Has Your Child Previously Broken Any Bones?
Specific Medical Conditions
Please tick if your child is prone to any of the following medial conditions
If you have ticked any of the above items, please note details regarding severity and any treatment required.