Holiday Kids Club 2019 Please enable JavaScript in your browser to complete this form.Children's Name, DOB and School year (one per line) *Parents or Guardians names *Residential Address *Phone Number(s) *Email Address(es)Medical InformationPlease list any medical conditions and any medication or special care your child/ren require. Dietary RestrictionsPlease indicate foods or beverages your child/ren should not consumeIs there anything else we should be aware of in caring for your child/ren? Please indicate foods or beverages your child/ren should not consumeIn case of emergency - Contact #1 - Name *In case of emergency - Contact #1 - Relationship to child *In case of emergency - Contact #1 - Phone Number *In case of emergency - Contact #2 - NameIn case of emergency - Contact #2 - Relationship to childIn case of emergency - Contact #2 - Phone NumberAuthorisation - I authorize the leader in charge of the MUBC Holiday Kids Club to arrange for my child to receive: *Such first aid and medical treatment as a trained first aid person may deem necessaryI authorize the use of calling an ambulance by a qualified medical practitioner if in his/her judgment is necessary.I accept responsibility for payment of all expenses associated with such treatment.All of these are required Please read the following statement and tick the box from which you wish to nominate for your child: *I DO permit photos/videos taken of my child to be displayed in church publications, e.g. website, newsletters, brochures, etc.I DO NOT permit photos/videos taken of my child to be displayed in church publications, e.g. website, newsletters, brochures, etc.Transport Authority - If I am unable to collect my child at the finishing time they may be transported home from the program with the following people:Disclaimer *I acknowledge that my child participates in the Holiday Kids Club at his/her own risk. I understand that Milton Ulladulla Baptist Church will take reasonable steps to provide a safe environment for my child, and to ensure that all equipment supplied by them for the activities is of a reasonable standard.I acknowledge that Milton Ulladulla Baptist Church Holiday Kids Club and Milton Ulladulla Baptist Church, its staff, volunteers and leaders, shall not be held liable for any accident or injury arising from and/or connected with this ministry.Thank you for providing this important information. The safety and wellbeing of the children is our primary concern.CommentSubmit