GPC Youth Permission Form • Presbyterian Church of Queensland

Graceville Youth Permission Form

Come have the best Friday night with us! Graceville Youth meets each Friday night during term time (6pm to 8pm), and we'd love to have your teen (grade 7-12, and grade 6s from term 3) come and join us. Come make friends and meet Jesus!

Each night includes fun games, dinner, a bible-based small group discussion, and a chance to hang out with kids in the local area. Dinner is on us the first time someone attends :) We ask our regulars to bring $5 for dinner.

To help us care for your teen, and to grant your permission for them to attend, please complete the following details:

Parent/Caregiver Contact Details

Name (First & Last) *

Email Address *

Teen Emergency Contact & Relationship *

Teen Emergency Phone Number *

Attending Teen Details

First Name *

Last Name *

Gender *

Date of Birth

School Grade *

School

Would you like to receive email updates (2-3 a term) about upcoming Graceville Youth events? *

YES - via parent and teen emails

YES - via parent email only

If you would like your teen to receive the email updates, provide their email address here:

Medical advice for the teen

Does your teen have any medical issues that the leaders should know about?

Does your teen have any allergies, intolerances, or other dietary requirements?

Does your teen have any other health/behaviour issues that the leaders should know about?

Medicare Number

Is the child subject to a custody order? (If so, please provide details to the Coordinator or Pastor)

Privacy Declaration

I give permission for appropriate photos/videos of my child/ren taken during the program to be displayed in a public place (e.g. church publication, presentation, internet site, approved social media platform) unless I explicitly advise otherwise. I give permission for the personal details given herein to be provided to appropriate leaders and/or relevant medical/emergency services as deemed necessary. I understand the details given herein will be used by leaders to contact myself and/or my child/ren and that the details will not be given to any third party, except as provided above. *

Please check box to acknowledge declaration

Authorisations & Expectations

By completing this form, I hereby give permission for my child/ren to attend all scheduled activities this year, unless we explicitly advise the leadership team otherwise. In doing so I undertake to provide the leaders with any information relevant to the wellbeing of my child/ren prior to them attending any and all scheduled activities. I authorise our child/ren to travel in a car driven by an approved leader or an approved parent, unless we explicitly advise the leadership team otherwise. (Your children will not be in a vehicle driven by a learner licence holder.) I understand that every effort will be made to provide a safe environment, however in signing this form I authorise the leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue or other services considered necessary. I also acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my child/ren being sent home &/or being temporarily or permanently prohibited from attending the activities of this group *

Please check box to grant permission