Child Information - Lighthouse Youth 2026 • New Vine Lakes Baptist Church

Lighthouse Youth 2026

Date: Every Friday of the school term

Where: Eastlakes Salvation Army Church

Time: Doors open @6:45pm pickup @ 9pm

Cost: $4/week cash

Please read all fields carefully, as there may be minor changes from previous years.

General Information

First Name *

Last Name *

Date of Birth *

School Year *

Phone Number

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

Brekkie Church

New Vine Windale

Medical Information

I give permission for the following drugs to be administered by a youth leader in the event that my child requires them.

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.

Tip: If you wish for this information to only be shared with limited persons please indicate

Please include any diagnosis, disabilities, or special concerns that you feel would be appropriate for the leaders to know, so our team can care for your young person to the best of their ability.

Emergency Contacts

Emergency Contact 1 *

Relationship to child: *

Emergency Number 1 *

Emergency Contact 2 *

Relationship to child: *

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.

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 separate permission slip will need to be completed.

I DO NOT permit photos or videos where my childs face appears to be displayed in church publications, e.g. website, newsletters, brochures, etc.

I DO NOT permit photos or videos where my childs face appears to be used in Youth Group/Church social media posts.

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