First Steps/Kids Connect/Ark Information • Epping Church of Christ

Child Information

Child's First Name *

Last Name *

DOB *

School Grade (or Preschool)

Male/Female *

Home Address

Home City

Home State

Postcode

Allergies or Asthma?

Anything else you think we should know? (ie special needs etc)

If you have an allergy/asthma or other medical plan we need to know about - please email

office@eppingchurchofchrist.org.au

Parent/Guardian Information

Parent 1 First Name *

Last Name *

Mobile Number

Email Address

Parent 2 First Name

Last Name

Mobile

Email Address

Address same as above?

Yes

If no - please complete below

Home Address if different (including postcode)

Caregiver (or person attending with Child/ren if not the parent)

First Name

Last Name

Mobile

Relationship to Child

In the event of an emergency please contact

Name

Mobile

Second Emergency Contact

Mobile

From time to time photos are taken in our Sunday morning program to document the fun of our sessions. These are used by our church only. The photos might be used on photo boards or internal newsletters.

We may use these photos on our Private Facebook Page (ECC Community)

I agree to the photos of our family being used for these purposes.

I agree *

YES

If you answered ''NO" Please advise about photos so we can respect your wishes

Other People Able to Check Your Children Out of Our Sunday Program

Name 1

Name 2

Name 3

Name 4