This form is for young people under the age of 18. This form and its Consent must be completed by the Primary Care giver/s.

Step 1 - Register the first young person in your care

Step 2 - Add further family members by clicking on the 'Add another family member' tab

This information is required so we can ensure that all participants are properly cared for during church activities such as children and family ministries, excursions, camps, etc. Please fill out all relevant fields of this form.


Your Privacy

Before you start filling in this form, we need to tell you what we’re going to do with the information you give us. You can read our Privacy Policy for further information on how we keep your information safe and secure.

On this form, we ask you for information. Some of this information can be used to identify the participant. We need this information so we can provide care while the participant is involved in church activities. Some of the information we ask for, such as medical details, are what is known as “sensitive” information. We need this information to care for the participant if they become unwell or are injured.

We’ll make sure that all of this information is protected all the time. Only people who need access to it will have it, and even then, they’ll only get access to the bits they actually need.

If you wish to access any personal information held about you or the participant please contact the Church Office on 8272 0258 or admin@upbc.org.au

Tip: (if relevant)

Tip: Young Person email and mobile details are not necessary and are only to be included if child is over 12 years of age.

Tip: Young Person email and mobile details are not necessary and are only to be included if child is over 12 years of age.

Tip: (if relevant)

Tip: Which school does the child attend?

Tip: Do you give permission for this participants' image to be used in church media/publicity?

Tip: Do you give permission for an ambulance to be called if deemed necessary (any costs being the parent’s /carer’s responsibility)?

Emergency Contacts

Tip: Who can we contact in case of emergency and Care Givers are not available? (enter name, relationship, contact number)

Medical Information

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

Tip: Please specify any special care / treatments required (e.g. HIV, no blood transfusions)

  • 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 young person/s parents/caregivers.

Tip: Please give details of any medication presently being taken (Name, Dosage)

Tip: Is the child/young person up to date with their Vaccinations?

Tip: Includes food allergies. Please give details of dietary restrictions if due to health problems.

Tip: Are there any special family arrangements we should know about ie custody details, family conditions etc

Signed Consent

I give my permission as the registered child's caregiver, for my child to participate in any Youth Ministry activities run by Unley Park Baptist Church Inc. and acknowledge that 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 accidently 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.

Please note that by clicking YES you are indicating that the information provided is true and accurate and that you agree to the above terms.

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).

Tip: Select today's date

Tip: Please click yes to indicate your consent