Impact Rego Form • Panania Anglican Church

Child information

One child per form please

Child Name *

Last Name *

Parent/Carer Name

Parent/Carer Mobile *

Tip: The number we should text or call if needed during church (please set your phone to buzz not ring)

Parent/Carer Email Address *

School Grade *

Tip: Impact is for kids in high school (year 7-12)

School attended

Health Information

Tip: Anything we need to know about your child that will help us care for them, including relevant medical conditions, learning distinctives, or dietary/physical restrictions.

Access Information

Tip: Any restrictions on who can pick your child up other than immediate family

Permission for emergency medical treatment *

Yes

Tip: We will always try to contact you, but you give us permission to seek immediate medical treatment if required

Media Permission *

Yes

Tip: I give permission for my child to appear in photos or videos of the ministry that may appear on social media