Willows Presbyterian Church Medical Form 2022

Which programs will your child attend at Willows during the year? Please click the appropriate ones.

Child details

Medical details

If no medicare number exists, please enter 000 and give a reason in the 'other information' field.

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).

Parent/Guardian details

Emergency contact details

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.

By clicking 'Submit' you agree to the terms and conditions.

Click 'Submit' to finalise.