Children’s Program Registration – Eastern Districts Alliance Church

I wish to register my child/ren for: *

Let us know which program you're registering for and the Team Leader will be in touch soon!

Parent/Guardian Details

Parent/Guardian 1 Name *

First

Last

Date of Birth *

Phone *

Email *

Relationship to Participant/s *

Eg. Mother, grandmother.

Parent/Guardian 2 Name *

First

Last

Please list another adult different to Parent/Guardian 1.

Date of Birth *

Phone *

Relationship to Participant/s *

Eg. Mother, grandmother.

Participant's Address *

Address Line 1

City

State / Province / Region

Postal Code

Participant Details

Child 1 Name *

First

Last

Date of Birth *

Gender *

Medicare Number

Medical Impairments, allergies or medications

Please list anything specific to your child that will help us better ensure their safety and that of others.

Child 2 Name

First

Last

Date of Birth

Gender

Medicare Number

Medical Impairments, allergies or medications

Please list anything specific to your child that will help us better ensure their safety and that of others.

Child 3 Name

First

Last

Date of Birth

Gender

Medicare Number

Medical Impairments, allergies or medications

Please list anything specific to your child that will help us better ensure their safety and that of others.

Child 4 Name

First

Last

Date of Birth

Gender

Medicare Number

Medical Impairments, allergies or medications

Please list anything specific to your child that will help us better ensure their safety and that of others.

Child 5 Name

First

Last

Date of Birth

Gender

Medicare Number

Medical impairments, allergies or medications and how to respond or treat them

Please list anything specific to your child that will help us better ensure their safety and that of others.

Parent/Guardian Agreement

I consent to appropriate use by EDAC of photographs or videos taken that include me and/or my child/ren. *

Eg. inclusion on EDAC's Facebook page, website or flyer.

I accept EDAC's Privacy Policy *

To view our Privacy Policy, please visit the 'About Us' section of our website.

Name