Child Enrolment Form 2021

This enrolment is active from the date filled in until 31 January the following year, at which point your child will need to be re-enrolled. One form must be completed for EACH child in your family who is part of Cornerstone's childrens' programs.

Details of Child

First Name *

Last Name *

Date of Birth *

Gender *

School Year *

Phone Number

Tip: home phone number

Home Address

Parent/Guardian Details

Primary Parental Contact (name & number) *

Secondary Parental Contact (name & number) *

Child's Health Information

Food Allergies

Non-food Allergies

Tip: for example - bees, latex

Other health information useful for childwork

Tip: anything that would be helpful for us to know in caring for your child (nappy size, disability, behavioural or learning difficulties, etc.)

People legally restricted from seeing child?

Tip: please name if applicable

Permissions & Consent

Permission to use photos/videos of children *

Tip: Cornerstone may occasionally use photos/videos of the children for internal use and/or publicity

Permission to be sent postal mail *

Tip: for example - children's leader(s) may send your child birthday cards, special invitations

Consent

Consent given by *

Tip: please enter your name

Parent/Guardian Consent

For child to participate fully in children's programs with Cornerstone Church

For those supervising the children's activity to administer basic first aid if necessary

In the case of a medical emergency, permission for those supervising or administering the children's activity, to secure proper treatment (by means of a qualified health profession) for child.

Date of this consent