Freedom Kids Registry • Freedom Church

First Name *

Date of Birth *

Last Name *

Age Group

MEDICAL INFORMATION

Please detail any medical conditions and/or allergies

Please detail any dietary requirements

Does your child use an asthma pump? *

Does your child carry an epi pen? *

Additional Comments

Tip: Please provide any other important medical or dietary information relating to your child

CONTACT DETAILS

Parent/Guardian Full Name *

Mobile Number *

Email Address

Emergency Contact Name *

Emergency Mobile *

PARENT/GUARDIAN CONSENT

Parent/Guardian Consent *

I consent to my child participating in the Freedom Kids program under the supervision of it's teachers and volunteers, who have been screened and approved for a Working With Children's Check (WWCC). I understand that my child may be included in group photos that could appear across Freedom Centre platforms.

Date *