Child Information • Portlife Church

Personal Information

All data collected on this form is used for Pastoral Care purposes.

Portlife's Privacy Policy is available here.

Child's First Name *

Last Name *

Gender *

Email Address

Tip: (Optional)

Mobile Number

Tip: If your child has a mobile phone, you can provide us with their number, if you both wish to do so.

Date of Birth *

School Grade *

School Attending *

Church attending

Tip: *Optional*

Home Address

To protect your child from possible embarrassment, but not to exclude them from the program, the following information is required:

Medical Concerns / Allergies

Emergency Contacts

Does this child have any medical concerns? (if yes, please state below) *

Yes

Medical Concerns Information

Does this child have any food or other allergies? (if yes, please state below) *

Yes

Allergy information

Emergency Contact 1 - Name *

Emergency Contact 1 - Phone No. *

Emergency Contact 1 - Email

Emergency Contact 2 - Name

Emergency Contact 2 - Phone No.

Emergency Contact 2 - Email

Permissions

Do you give permission for us to use photographs and videos of your children in promotional material, including (but not limited to) social media and the Portlife Church website? *

Yes

Is there any other information which might assist us to care for your child? (if yes, please state)

By submitting this form, you agree to the following:

I give permission for Portlife Church to supervise and provide first aid (if necessary) for my child. I give permission for my child to travel by all modes of public and private transport whenever the need arises. I also allow my child to participate in ALL events completed at Portlife Church and at any other location.

Please note that if you fail or neglect to provide sufficient and current information to enable the proper treatment of your child, no liability will be accepted for any injury or illness, which your child may suffer as a result. An ambulance may be called in the case of a medical emergency, which the parent/caregiver will assume all responsibility for. If an ambulance is called, a parent/caregiver will either travel with the ambulance, or meet the child/young person at the hospital.

The above information is correct and I give permission for Portlife Church to provide supervision for my child in accordance with its Child Safe Policy.