Medical Form 2025

Child details

First Name *

Last Name *

Gender *

Date of Birth *

School Grade in 2025 *

Medical details - please leave empty if none exist

Does you child have any dietary requirements? *

Give a short description of any dietary requirements.

Does your child have any further allergies? *

Give a short description of any allergies (medication, animals, plants etc).

Does the child need to take any medication during the program? *

Give a short description of medication that needs to be taken

Does your child have any other medical, psychological, social, behavioural or other conditions? *

Please list any other medical, psychological, social, behavioural or other conditions.

Other details

Photos/videos may be taken during the programs by designated team members which could be displayed in a public place (e.g. church publication, presentation, internet site, Facebook page).

Do you give permission for photos and videos to be taken of the attendee? *

Are there any specific activities you do not want the attendee to participate in? *

Please list any activities you DO NOT want your child to participate in.

Is there any other information we need to know (i.e. custody order)?

Please list any other information we need to know.

Parent/Guardian details

Parent/Guardian Name *

Parent/Guardian Mobile Number *

Email Address *

Home Address *

Home Suburb *

Home State *

Home Postcode *

Emergency contact details

If an emergency happens we will first contact the parent's phone number (entered above) . Please enter below 2 other people we can contact in case the parent doesn't answer.

Emergency Contact Person (name) *

Emergency Contact Person (phone) *

Emergency Contact Person 2 (name) *

Emergency Contact Person 2 (phone) *

Other programs

Please enter which programs your child will attend at Willows during the year.

Programs permission *

Terms and Conditions

I give permission for the personal details given herein to be provided to appropriate leaders and/or relevant medical/emergency services as deemed necessary. I understand the details given herein will be used by leaders to contact myself and/or my child/ren and that the details will not be given to any third party, except as provided above.

By completing this form, I hereby give permission for my child/ren to attend all scheduled activities, unless we explicitly advise the leadership team otherwise. In doing so I undertake to provide the leaders with any information relevant to the wellbeing of my child/ren prior to them attending any and all scheduled activities.

Willows Presbyterian Church