St Luke's Children's Ministry Registration

Thank you for registering your child to join St Luke's Children's Ministry! Please fill in the form below so that we will have all the details we need to take good care of your child. You can also fill in the form online at www.stlukesliverpool.org.au/for-children.

Child

First Name *

Preferred Name

Middle Name

Last Name *

Sex *

Date of Birth *

Allergies / Medical Conditions

School

School Grade

Media Permissions *

Yes

Tip: I give permission for photos/videos of my child/young person to be taken that may be used to advertise the group

Special Needs *

Yes

Prohibited Persons

Tip: Is there anyone who is legally restricted from seeing your child?

Child Contact Details

Email Address

Phone Number

Mobile Number

Home Address

Mailing Address

Home Address *

Home Address Line 2

Home Suburb *

Home State *

Home Postcode *

Home Country *

Mailing Address

Mailing Address Line 2

Mailing Suburb

Mailing State

Mailing Postcode

Mailing Country

Parent/Guardian Details

Parent/Guardian Name *

Parent/Guardian Address

Tip: If different from child's address

Parent/Guardian Phone Number

Parent/Guardian Mobile Number

Parent/Guardian Email Address

Comments

Tip: Do you have any questions, concerns or additional comments for us?