Child's Details

Permissions and Medical Details

Parent/Carer's Details

We are required to have details for 2 parents/carers or trusted contacts who can make decisions in an emergency. These people need to be contactable during youth programs. The first contact will also be sent information about future programs via email.

First Parent/Carer or Emergency Contact

Second Parent/Carer or Emergency Contact

I declare that the information provided above is true and correct. In consideration of the facilities provided by you for our child, I hereby absolutely release and discharge the Bracken Ridge Baptist Church and its employees, agents and volunteers from and against all claims whatsoever arising out of death, personal injury, or loss of or damage to personal property that we or the child may suffer or sustain in the course of their involvement in programs at Bracken Ridge Baptist Church and we hereby indemnify and agree to keep indemnified the Bracken Ridge Baptist Church and its employees, agents and volunteers against all claims whatsoever by us or the child or by any person claiming through us or through the child on our behalf or on the behalf of the child in any way arising, and this discharge may be pleased in bar to any such claim.

Provided that the above does not apply to any claim or any claim to the extent that the Bracken Ridge Baptist Church is indemnified by a policy of insurance issued by a solvent insurer and we further agree that in the event of injury to our child, you are authorized by us to obtain at our expense any medical, ambulance or like services which you in your absolute discretion think necessary or desirable.

Child Involvement Statement

- Please read this with your child - 

Do you agree to listen and respect leaders? 

Do you agree to interact with others in an encouraging and kind manner?

Do you agree to take care of our resources and space?

Do you agree to have heaps of fun?