Children and Youth Program Registration • St Thomas' Burwood

This form is to be filled out by the parent/guardian of the participant 这份表格由参与者的家长/监护人填写

This form is a copy of Children or Youth Ministry Registration form (May 2023) from the Anglican Diocese of Melbourne Parish and Authorised Congregation Safe Ministry Resources

This form is intended to assist leaders in case of any medical emergency during the course of participation in any children’s or youth ministry activity. Please complete fully. This form is to be filled out by the parent/guardian of the participant.

这份表格是从澳大利亚墨尔本圣公会教区2011年7月发布的《关乎义务附录C：医疗信息/同意书》中复制而来。

墨尔本教省圣公会教区儿童或青少年事工参与登记表格。
圣多马圣公会儿童与青少年事工

此表格旨在协助领导者在儿童或青少年事工活动中发生紧急医疗情况时提供帮助。请完整填写并尽快提交。

Children's or Youth Ministry Registration form 医疗信息 / 许可表格

St Thomas' Children and Youth Programs and Ministeries 圣多马堂儿童青少年活动与事工

Choose which Program(s) you would like to register for. 请选择您要报名的活动

Children and Youth Programs 儿童与青少年活动

Child's Details (Participant) 孩子信息 (参与者)

First Name 名字 *

Preferred Name

Last Name 姓氏 *

Date of Birth 出生日期 *

School Grade

Home Address 地址

Suburb 郊区名

Home Postcode 住址邮政编码

Email Address 电邮

Are you of Aboriginal and/or Torres Strait Islander Origin? 你是否是土着和/或托雷斯海峡岛民？

Yes, Aboriginal

Yes, Torres Strait Islander

Permission 许可/同意

Permissions (please scroll)

I consent to my childs participation in the activities I have received notification of. I will encourage my child to participate and co-operate with the leaders and other participants.

I give permission for my child to participate in activities held outside, or away from, this church when I have received due notification.

I give permission for my child to be transported in private cars or buses arranged by the leaders of this church

I authorise the leaders in charge of any activity conducted by this church to consent on my behalf, where it is impractical to communicate with me for my child to receive medical/surgical treatment as may be deemed necessary. I am also responsible for the cost of any medical treatment deemed necessary.

I understand there may be photographs and/or video footage of my child during this activity and am willing for my child to be so filmed in appropriate settings. I am also willing for photos or footage to be used to promote the ministry in a way that does not identify their name or details. My child is also willing for this to take place.

Parent / Guardian 1 家长一和/或监护人

Relationship to Child (Parent / Guardian 1) 请选择家长或监护人 *

Full Name (Parent / Guardian 1) 全名（家长/监护人一） *

Mobile Number (Parent / Guardian 1) 手机号码 *

Email address (Parent / Guardian 1) 电邮 *

Parent / Guardian 2 家长二/或监护人

Relationship to Child (Parent / Guardian 2) 请选择家长或监护人

Full Name (Parent / Guardian 2) 全名（家长/监护人二）

Mobile number (Parent / Guardian 2) 手机号码

Email Address (Parent / Guardian 2)

Optional Emergency Contact 紧急联系信息

Name 名字

Relationship to participant 与参与者的关系

Email 电邮

Tip: If applicable 如需要

Phone 电话号码

Mobile 手提号码

Sign Form

Parent or Guardian acknowledgement 家长或监护人确认 *

Sign Form

Children's or Youth Ministry Registration form 医疗信息 / 许可表格

St Thomas' Children and Youth Programs and Ministeries 圣多马堂儿童青少年活动与事工

Child's Details (Participant) 孩子信息 (参与者)

Permission 许可/同意

Parent / Guardian 1 家长一和/或监护人

Parent / Guardian 2 家长二/或监护人

Optional Emergency Contact 紧急联系信息

Doctor/ Health Contact 医生/医疗联系信息

Sign Form