Kids Church Registration 2025

Child's First Name *

Child's Last Name *

Date of Birth *

Gender *

School *

School Grade *

Dietary Requirements

Dietary - Other

Parent / Carer First Name *

Parent / Carer Last Name *

Street Number & Name *

Suburb *

Postcode *

Parent / Carer Mobile *

Parent / Carer Email *

Permission to Publish *

Tip: Please select 'Yes' if you're happy for BBC to use photo or video footage of your child in promotional material. i.e. On our website or in printed media.

Parent/Carer Permission *

Tip: I consent to my child attending Kids Church. In any emergency, should I not be contactable, I authorise the leaders in charge to arrange for my child to receive such first aid, medical or surgical treatment as the leader may deem necessary at any time during the activities. I further authorise the use of Ambulance and/or anaesthetic by a qualified medical practitioner if in his/her judgement it is necessary. I accept responsibility for payment of all expenses associated with such treatment. I agree to indemnify and hold harmless the Busselton Baptist Church and any individual staff or voluntary leaders against all claims arising out of any injury to my child and the relevant activity being undertaken, unless such injuries result from a failure in the duty of care of the Busselton Baptist Church, individual staff or volunteer leader.

Any further comments:

Child's Details

Parent / Carer Details

Consent