Salties Medical Form 2024

Child details

First Name *

Last Name *

Gender *

Date of Birth *

School Grade in 2024 *

Give a short description of any dietary requirements

Give a short description of any allergies

Does the child need to take any medication during the program?

Are there any other medical / behavioural conditions we need to be aware of?

Medical details - please leave empty if none exist

Is there any other information we need to know (i.e custody order)?

Medicare Number (please enter numbers only, no spaces or /) *

Tip: If no medicare number exists, please enter ‘000’ and give reason in ‘other information’ field

Other details

Photos / videos may be taken during the programs by designated team members which could be displayed in a public place (e.g. church publications, presentation, internet site, facebook page).

Do you give permission for photos and videos to be taken of the attendee? *

are there any specific activities you do not want the attendee to participate in? *

Parent / Guardian details

Parent / Guardian Name *

Mobile Number *

Email Address *

Home Address *

Home Suburb *

Home State *

Home Postcode *

Emergency Contact Details

First contact in emergency (name) *

First contact in emergency (phone) *

Second contact in emergency (Name) *

Second contact in emergency (Phone) *

Other programs

Which programs will your child attend at RRAC during 2023?

Programs permission *

I give permission for staff to SMS with relevant details concerning the activities that my child is enrolled in *

Tip: For example: updates, permission slips and reminders for kids activities

Terms and Conditions

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.

By completing this form, I hereby give permission for my child/ren to attend all scheduled activities, 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.

By clicking 'Submit' you agree to the terms and conditions.

Click the button to the right to register another child or click 'Submit' to register.