Child Information - Lakes Kids 2025 • New Vine Lakes Baptist Church

General Information

First Name

Last Name

Phone Number

Date of Birth

School Year

Parent's or Guardian's Names

Parent's Phone Contact

Parent's Email Contact

Home Address

Home City

Home State

Postcode

Locations

New Vine Lakes Baptist Church

Lighthouse Youth

Breakfast Church

Dietary Issues

Is there anything your child can not eat and/or drink?

Please indicate foods or beverages your child should not consume:

Medical Information

Please list any medical conditions or allergies, and any medication or special care they require. If your child is anaphylactic to any substance please provide information regarding EpiPen and management plan.

Allergies

Emergency Contacts

Emergency Contact 1

Emergency Number 1

Emergency Contact 2

Emergency Number 2

Parent Authority

Parent Authority *

I accept responsibility for my child as soon as the program is finished.

I authorise the leader in charge to arrange for my child to receive such first aid and medical treatment as a trained first aid person may deem necessary.

I authorise the use of calling an ambulance in emergency.

I accept responsibility for payment of all expenses associated with such treatment.

I accept that if my child goes to the front of the church during a service they will be broadcast on our live stream.

Please read the follow statement and tick the boxes from which you wish to preclude your children:

Transport and Photography

I DO NOT give permission for my child to participate in activities outside of the normal meeting complex except where they are within reasonable walking distance.

I DO NOT give permission for my child to be transported in private cars arranged by the leaders of the group. Where this applies a seperate permission slip will need to be completed.

I DO NOT permit photos taken of my child to be displayed in church publications, e.g. website, newsletters, brochures, etc.

LHY Only: I DO NOT give permission for my child to receive transport on the youth bus when available.

Transport authority: If I am unable to collect my child at the finishing time they may be transported home from the program with the following people:

Thank you for providing this important information. The safety and wellbeing of your child is our primary concern.

Parent completing form (Name in Full)

Date form completed