Playtime Registration Form

To care well and for the safety of your child(ren) here at St Basil's, there is some information we need.

Carer's Information

First Name *

Last Name *

Relationship to Child(ren) *

Email Address *

Mobile Number *

Home Address

Child's Information

Child's First Name *

Child's Last Name *

Child's Preferred Name

Gender

Date of Birth *

Please let us know if your child has any medical concerns we should be aware of.

Please select any sections relevant for your child:

Medical Allergies

Medical Anaphylaxis

Medical Conditions

Medical Dietary Requirements

Disabilities

Please describe condition / provide treatment plan / list any requirements that we should be aware of.

Child #2's Information

Child #2's First Name

Child #2's Last Name

Child #2's Preferred Name

Child #2's Gender

Child #2's Date of Birth

Please let us know if your child has any medical concerns we should be aware of.

Please select any sections relevant for your child #2:

Medical Allergies

Medical Anaphylaxis

Medical Conditions

Medical Dietary Requirements

Disabilities

Please describe condition / provide treatment plan / list any requirements that we should be aware of.

General Information

I give permission for my child(ren) to appear in photos and/or videos that may be used for promotion at St Basil's.

Photo Permission

I understand that my child(ren) is/are under my supervision at all times.

Would you like us to contact you about our other kids programs?

Kids Church on Sunday (preschool - Year 6)

Youth Group on Sunday (Years 6 - 12)

Data Privacy

The leadership team of St Basil's Artarmon Anglican Church will treat this information confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. If you wish to access this information or have any queries in relation to the manner in which we handle your personal information, please contact office@artarmonchurch.org.