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Children's & Youth Ministry Registration Form

Which group are you registering your child for? *

JaM (aged 3-5 Preschoolers)

Junior Church (Primary aged)

Remix (Secondary Students)

Name *

Sex: *

Male

Female

Date of Birth: *

School currently attending (if applicable):

Current School Grade: *

Language/s spoken at home: *

Siblings (include ages):

Allergies (food, medications etc. Leave blank if n/a)

Medication required:

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Please note that medications for anaphylaxis and asthma, along with any action plans must accompany your child in class.

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Acknowledgment that action plans need to be emailed to Jenny.lau@cccv.org.au

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Please state below any relevant information that will help us look after your child better, e.g. medical conditions.

Parent/Guardian (also emergency contact) #1 Name: *

Relationship to child *

Contact number: *

Email Address *

CCCV Congregation *

Cantonese

Mandarin

Lifespring (English)

Parent/Guardian #2 Name:

Contact number:

Email Address:

CCCV Congregation

Cantonese

English

Mandarin

I agree that the above information is correct and up to date and I will inform the Children's Ministry Team Leader of any relevant changes. *

I agree

I consent for teaching leaders of CCCV Children’s/Youth Ministry to take photographs and/or videos of my child for church use.

Agree

Disagree

Signaturecommon.clear

Date *

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