Awaken MCC Personal and Medical Information Form (2022) • Mueller Community Church

Mueller Community Church (MCC) is committed to protecting the rights, interests and wellbeing of all children involved in its activities and to providing a safe and supportive environment.

All children have a right to protection from harm irrespective of its source. Protection from harm and the risk of harm, is fundamental in maximizing a child’s potential.

MCC is committed to ensuring that all Leaders in its activities involving children are aware of and comply with the Child Protection Policy, mandatory reporting requirements and screening requirements under legislation. All leaders have Blue Cards and have completed a child safety certified course and are held to high standards of accountability.

MCC collects the information on this form to ensure that your child’s participation in Children and Youth Ministries is as enjoyable and safe as possible. Failure to supply this information will prevent your child’s participation in Children and Youth Ministries as we are committed to providing a caring and safe environment.

Personal information collected by us is only used or disclosed for the purpose of running Children and Youth Ministries at Mueller Community Church. However, in order to provide a caring and safe environment this information may be used or disclosed to provide emergency health care involving your child.

In an effort to provide the best possible care for your child, we ask to be advised if any of the details in this form change.

Participant details

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

Participant Email *

Participant Mobile

Participant Medical Information

Does your child have any of the following?

Allergies *

Yes

Please provide details (eg bee stings, penicillin, aspirin)

Dietary Requirements *

Yes

Please provide details (eg lactose intolerant)

Other relevant medical information

Does your child take medication? *

Yes

Please provide details (including if the medication is taken during the program)

Can we provide your child paracetamol if required? *

Yes

Rate your child's swimming ability *

Please provide any other helpful information (eg asthma, bedwetting, migraines, dizzy spells, custody issues, physical disabilities, behavioural issues)

Family & Emergency Contact Details

Family

Name of Parent/ Guardian *

Parent/ Guardian Email *

Parent/ Guardian Mobile *

Home Street Address *

Suburb *

Postcode *

In the case of an emergency, please list telephone numbers where a relative or friend may be contacted during the course of the program if the parents/guardians listed above are unable to be contacted.

Other Emergency Contact

Name of Emergency Contact 1 *

Mobile Number *

Relationship to child *

Signature of Parent/Guardian

I am aware, in signing this document for 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.

I consent to my child participating in all activities associated with the program that they are a part of, including participation in activities held at external venues and including transportation to and from these venues. I also consent to the appropriate use of photographs and videos taken of my child at the program to be used for advertising and promotional means on a variety of media platforms.

I permit from time to time, when the need arises and with permission from Elders, the Youth Pastor or equivalent, that the Awaken leaders contact my young person, either by phone call, email or group messaging.

I permit the Youth Pastor, or another person approved by the Youth Pastor to pick-up and drop-off my young person for the purpose of getting them to and from events run by Mueller Community Church.

In the event of any emergency where my nominated contact people are unavailable:

I authorise the leaders to engage Emergency Services as they deem necessary.
I accept the responsibility for payment and agree to pay medical, transport and any other related expenses.

I recognise that being part of a community involves mutual care and consideration and therefore agree that unacceptable behaviour, as deemed by the Awaken Leaders, or failure to follow event specific rules and guidlines may result in my child being sent home and/or being temporarily or permanently prohibited from attending the program.

I confirm that the information contained in this application is true and correct.

I agree to inform the leader of any change to these details.

Signature of Parent/Guardian *

Date