Brisbane - Families - 3. Additional Child Connect Form • Citipointe Church

Citipointe Families New Child Registration

One at a time, you can add each child and tell us anything else we need to know.

We are so happy to be doing family life with you at Citipointe. In order to include a new child in our database, we just need a few details and your permission to collect that information.

Parent Information

I/We are:

Just Visiting (Kids Big Sunday, On holidays eg)

New to Citipointe

A Citipointe Church Member

Visiting from another Citipointe Location

Your Full Name: *

What is your relationship to the child:

Child's Information

First Name of Child *

Last Name of Child *

Mobile Number (of Guardian) *

Date of Birth of Child *

Is your child of school age (ie they do or could attend Prep - Grade 12)?

Yes

School Grade *

Gender of Child

Consent for the Child Listed Above

Medical Treatment: 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, Citipointe Church, it's staff and volunteers acting on behalf are hereby released from any liability in the event of any accident or misfortune, damage or loss that may occur to my child or property. In the case of emergency, I hereby give permission to the First Aid Staff to ensure proper treatment for my child. I have given details above of any health information about my child that the First Aid Staff need to know.

Involvement: I being the parent/guardian of the said child give my consent that my son/daughter may participate in any activities they choose whilst in Citipointe's care, wheather it is games, sports etc

Photography & Video: I being the parent/guardian of the said child hereby give my consent for my son/daughter to be captured in both video and photographs at Citipointe Church. Citipointe Church reserves the right to use this material for promotional purposes.

Name of Parent Giving Consent:

Date of Medical Consent: *

Date of Involvement Consent: *

I consent to the Photography and Video statement above:

Yes

I consent to the Photography and Video statement above:

I do not consent to the Photography and Video statement above:

Tip: Insert date

PRIVACY POLICY

Citipointe Church considers any information you share with us to be private. Looking after your personal information is something we value as an organisation and we hope you feel confident that any information you share with us will be looked after and safely used. For more information about our privacy practices please visit our website at citipointechurch.com/privacypolicy.

Citipointe Families New Child Registration

One at a time, you can add each child and tell us anything else we need to know.

Parent Information

Child's Information

Medical Details of Child Listed Above

Consent for the Child Listed Above