FUSE Registration Form

All Youth are required to complete this Registration Form before attending Youth.

Youth's Personal Details

First Name *

Last Name *

Date of Birth *

Gender *

School Name *

School Grade *

Youth's Contact Details

Mobile Number *

Email Address *

Home Address *

Home City *

Home Postcode *

Parent/Carer Contact Details

At least one parent's or carer's contact details are to be provided, and be the person responsible for picking the child up after each event.

Parent/Carer 1 - Full Name *

Parent/Carer 1 - Mobile No. *

Parent /Carer 1 - Email Address *

Relationship to Child (e.g. mother / father / guardian) *

Parent/Carer 2 - Full Name

Parent/Carer 2 - Mobile No.

Parent/Carer 2 - Email Address

Relationship to Child (e.g. mother / father / guardian)

CONSENT

By completing this Form and submitting it, means you have read the following and give consent and permission to Berwick Church of Christ as follows:

I consent to my child becoming a member of Berwick Church of Christ Youth Ministry known as FUSE Youth. I give consent for my child to participate in all activities while attending FUSE Youth programs and activities, and any Y&Y services and events. I acknowledge the staff and volunteers of Berwick Church of Christ will take all possible care but will not be held responsible for any unforeseen accident, illness or loss of property arising.

I consent that in the event of any illness or accident for the employing of medical or hospital assistance as my child requires. I understand that I shall be notified as soon as practicable should such an incident occur. I accept the responsibility for payment of any expenses incurred for such assistance.

If during a FUSE Youth program/activity or Y&Y service/event my children's behaviour is deemed by Berwick Church of Christ staff or volunteers to be inappropriate or compromises the safety of other children or volunteers, I understand that I will be contacted as soon as possible and my child may be removed from the program or activity as necessary.

I give permission to Berwick Church of Christ to photograph or video my child and to use his/her image, photograph or video in printed or digital materials, on the Church website and social media accounts produced by the Berwick Church of Christ and any of its related ministries. We DO NOT include the name of your child or "tag" them. Possible uses include, but are not limited to, reports, brochures, websites, social media posts, promotional videos and multimedia presentations.

I give permission for my child, when attending any FUSE Youth programs during the 2020 year, to be driven to and from youth activities by Youth Leaders that have been authorised by the Berwick Church of Christ.

I am aware that the Youth Leaders are bound by the Berwick Church of Christ Policies and Code of Conduct and that they are committed to providing a Safe Church environment at all times.

Please check this box once you have read and understand the Consent Section above and agree to give consent to the Berwick Church of Christ. *

Yes, I have read all the above and give my consent to Berwick Church of Christ

Date Consent Given *

FUSE Registration Form