Please enter your child's full name

Please choose your child's school year from the list

Child 1

Child 2

Child 3

Child 4

Enter your email address to receive Kids' Club updates

Enter a contact number - preferably a mobile

Street

Suburb

Post code

Please enter the name of an additional person to contact if the parents/guardians are unavailable.

Phone Number

If yes please provide details. All information is kept in strict confidence.

In the unlikely case of an emergency, I understand that Kids’ Club Leaders will make every effort to contact parents/guardians using the details above. If for some reason contact is not possible, I give permission to the doctor chosen by the Kids’ Club leaders to secure proper treatment for my child as named. I also understand that photos may be taken of my child at Kids’ Club to be used solely within the group unless specific permission is sought. By submitting this form, I give permission for my child/ren to participate in Kids’ Club run by Harrington Park Anglican Church. (Please select today's date and "Submit")