(Current 2025) KFC Youth Medical and Permission Form • Kingborough Family Church

KFC Youth Medical & Permission Form

In order to provide the best level of care while your child/ren are under our supervision, we require that you fill out and return the registration form below. The information below will be treated confidentially within our team.

Personal Details

Youth First Name *

Youth Last Name *

Date of Birth: *

Address: *

Suburb: *

Postcode: *

Youth Email:

Youth Mobile:

School Grade:

Parent/Guardian #1

1st Prt / Gdn Name *

1st Prt / Gdn Relationship to child *

1st Prt / Gdn Email Address *

1st Prt / Gdn Mobile *

Parent/Guardian #2

2nd Prt / Gdn Name

2nd Prt / Gdn Relationship to child

2nd Prt / Gdn Email Address

2nd Prt / Gdn Mobile

Is there any custody arrangements with your child? (please provide details):

Emergency Contact (other than parent/guardian listed above)

Please fill out section below, if only 1 parent/guardian listed above.

Emergency Contact Name and Mobile

Permission to Collect

Who will collect your child at the end of the program? Please list anyone who will be collecting your child (including yourself).

Name/Contact Number (Permission to Collect) *

Medical Information

The following information is supplied (in confience) to assist leaders in the event of an incident.

Allergies

Does your child have any allergies? (Please provide a list of allergies and the severity) *

Does your child have an anaphylaxis plan?

YES

If you child has an anaphylaxis plan, please provide us a copy either in person or by emailing youth@kfc.church.

Asthma

Does your child have Asthma? *

YES

Does your child have an asthma action plan?

YES

If your child has an asthma action plan, please provide us a copy either in person or by emailing youth@kfc.church.

Medical Condtions

Does your child have any medical conditions (please detail below)? *

Dietary Conditions

Does your child have any dietary requirement (please detail below)? *

Other Medical Information

Any other medical information we need to be aware of?

Medical Authorisation

Should I/we be unavailable in the case of an emergency involving my/our child. I/We hereby authorise the Leaders to arrange for such Medical or Surgical treatment, and the administration of medication such as analgesics, as may be deemed necessary. I/We indemnify Kingborough Family Church against all cost arising from such action.

Do you agree to the medical authorisation? *

YES

Photo/Video Release

We may occasionally take photos or videos at youth events to share on social media and promote future programs. These will only be used where permission has been given and in line with our ChildSafe Policy.

No names will be published.
Media will focus on activities, not individuals.
All content is reviewed for appropriate use.

For more information, please see the AGC Child Safety & Wellbeing Policy

I give permission for photos/videos of my child to be used for our advert/promotion material or placement on website. *

YES

I give permission to take/use photos/videos of my child for social media. *

YES

Drivers Release

At times, our youth events may be held off-site, requiring the transportation of children to and from the venue. In these instances, we typically hire a bus. However, there may be occasions where a small number of participants will need to be transported by car.

When car transport is used, please be assured of the following:

All drivers hold a full driver’s licence.
Leaders will always comply with road safety laws and our organisation’s Child Safety & Wellbeing Policy.
There will be two leaders in the vehicle and/or multiple youth to ensure appropriate supervision and accountability.

I give permission for a designated youth leader to drive my child to and from an event in a car. *

YES

Communication Release

Do you give permission for leaders from KFC Youth to contact your child directly via text message or phone call to share updates or important information regarding youth events and programs?

All communication will be conducted in accordance with our Child Safety & Wellbeing Policy, ensuring appropriate and accountable interactions at all times.

I consent to a designated youth leader contacting my child directly. *

YES

Your Agreement With us

I understand that although the leaders will take all reasonable care to ensure both the comfort and safety of my child, there is still a risk that an accident may occur.

Name *

I agree. *

YES

Date (today) *

Childsafe Information

If you have any questions about our Childsafe Policy, please don’t hesitate to contact us at youth@kfc.church.

For more detailed information, you can also refer to the AGC Child Safety & Wellbeing Policy.