We will ensure all appropriate care is taken. If an emergency were to arise, we will make every effort to contact you or your emergency contacts, before enacting our response.

Only complete fields where relevant. Leave blank if does not apply

• Any action plans will need to be reviewed on a yearly basis with the family doctor
• Where an action plan requires the use of an EPIPEN, no leaders or helpers are required by the Church to administer it. In the event of an emergency, leaders will need to obtain the child's parent/s.

I give my permission as the registered child's caregiver, for my child to participate in any Children's Ministry/Youth activities run by Unley Park Baptist Church Inc. and acknowledge that the risk of injuries is inherent in physical activities. While I am aware that leaders will take all due care, I recognise that accidents may occur.

In the event that my child becomes ill or accidentally injured, I understand that those representing Unley Park Baptist Church Inc. will follow the instructions given above, administer first aid as necessary and contact Ambulance Services in an emergency.

The action of submitting this completed form electronically takes the place of a signature. This sufficiently satisfies the electronic signature provisions set out in section 10 of the Electronic Transactions Act 1999 (ETA)

Please note that by submitting this form you are indicating that the information provided is true and accurate and that you agree to the above terms.