Arana Youth Registration Form

To best care for our Arana Youth participants, we ask you fill out this confidential form below. Please fill out one registration per youth. You may use the 'Add Another Youth' button at the bottom of the page to register another youth from the same family.

Youth's Personal Information

First Name *

Preferred Name

Last Name *

Gender *

Date of Birth *

Email Address

Mobile Number

School Grade

School *

Church (if applicable)

Home Address

Home Suburb

Home State

Home Postcode

Emergency Contacts

In case of an emergency, please list phone numbers where you, as well as and alternative parent/guardian/relative/carer, may be contacted during the course of our program. Information about Arana Youth's Program will be sent to the emails provided.

Parent / Guardian 1

1 First Name *

1 Last Name *

1 Relationship *

1 Phone Number *

1 Email Address *

Parent / Guardian / Relative / Carer 2

2 First Name *

2 Last Name *

2 Relationship *

2 Phone Number *

2 Email Address

Medical Information

Can your child be given paracetamol as a pain killer? *

Yes

Please indicate if your child has any allergies (Please specific if they are anaphylactic and are required to carry an epipen)

Please indicate if your child has any dietary requirements

Please indicate if your child has any specific medical conditions that could impact their participation in Arana Youth activities (Eg. Asthma, diabetes, epilepsy, fainting, hyper/hyrpo-activity, heart problems ect.)

Please indicate if your child has any behavioural needs we should be aware of (Eg. ADD, ADHD, formal counselling, anxiety, depression ect.)

Please provide details if your child has any activity restrictions (Eg. Poor swimming ability)

Arana Youth Agreement

I am aware, by submitting this document regarding my child's participation in this program, that certain elements of the program could be physically and emotionally demanding. Furthermore, I understand that certain inherent risks and dangers may exist in the activities in which my child will be participating. I acknowledge that while the organisation and its leaders will make every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of the organisation, its leaders and staff. In the event of any emergency where my nominated contact people are unavailable:

I authorise the leaders to obtain medical advice and/or assistance which they deem necessary.
I accept the responsibility for payment and agree to pay medical, transport and any other related expenses.
I confirm that the information contained in this application is true and correct.

Name of Person Making Agreement *

Agreement Signed *

Yes

Privacy Policy

The Arana Hills Church of Christ acknowledges and respects the privacy of individuals. We support and endorse the national Privacy Principles wherever personal information as defined by the Act is collected by us.

In accordance with the national Privacy Principles

We will only collect personal information from you with your prior knowledge and consent;
We will only use personal information provided by you for the purpose of which it was collected;
We will not disclose your personal information to a third party without your consent;
We will not disclose your personal information to other institutions and authorities except if required by law or other regulations;
We will remove personal information from our records when it is no longer required (except where archiving is required)
We have processes and policies to protect the personal information that we have under our control from; Unauthorized access; Improper use; Alteration; Unlawful or accidental destruction and accidental loss