Form

Parent's Name

First Name Last Name

Spouse's Name

First Name Last Name

Child 1 *

First name Last name DOB and grade

Child 2

First name Last name DOB and grade

Child 3

First name Last name DOB and grade

Address *

Street Address
Street Address Line 2
City	State / Province
Postcode	Country

Phone

Mobile *

-

E-mail *

Attend Church Regularly?

Yes No

I found out about C3 Victory through:

Media Release: Do you give permission for C3 Kids and C3 Victory to use your child's image and audio recordings for promotional purposes?

Yes No

Medical information

Medical Conditions Dietry requirements Allergies Other

Details

Duty of Care: I understand that while all due care will be taken by C3 Kids and its representatives, my submission of this document constitutes a complete and unconditional release of all liability of C3 Kids and its representatives, and C3 Church Victory and its representatives, its proprietor and operators to the greatest extent allowed by law in the event of me and / or my children suffering loss, injury or death during C3 Kids events. I also indemnify C3 Kids and its representatives, and C3 Church Victory and its representatives, proprietor and operators against any costs, damages and losses that may result from any incidents that occur during C3 Kids events or related activities. I give permission for first aid to be administered to my child by trained first aid representatives as the need arises.

yes no

NAPPY CHANGE POLICY - 1-5 YEAR OLDS AT CENTRAL CAMPUS ONLY

To provide Parent/Guardians a chance to attend Sunday morning church, C3 Kids Leaders will change nappies during the program if needed. Written Parent/Guardians permission MUST be given before nappy can be changed. No nappy will be changed without written and signed permission. Only the Ministry Leader, Program Leader or Assistant Program Leader are permitted to change nappies. Leaders are to be trained through C3 Kids on the nappy change procedure. Nappy and nappy accessories will be supplied by C3 Kids. As the nappy is changed the leader is to face the other children in the Program. No nappy will be changed unless a minimum of 2 leaders are present. NAPPY CHANGE PERMISSION FORM: I give permission for a C3 Kids leader to change my child/ren nappy if needed. I have read and fully understand the C3 Kids Nappy change policy and procedure.

yes no

ALIVE SUNDAYS (CENTRAL CAMPUS, YR 5-7 ONLY)

Alive Sundays is the Grade 5-7 Program which is held at the Ministry Centre (Level 1/5 Hopetoun St, Charlestown) on Sunday mornings. Children walk between Charlestown Square and the Ministry Centre (approx 5 min). Grade 5-7 need to be picked up from The Reading Foyer after the conclusion of the service. Parents must bring their rego receipt to hand into the child’s connect group leader, when collecting children. I give permission for my child to walk between Reading & the Ministry Centre on Sunday mornings.

yes no

C3 Kids Registration Form