SDBC Medical and General Consent Form (Youth)

Your Details

Participant Details

First Name *

Gender *

Home Address *

School

Church (if any)

Mobile Number

Last Name *

Date of Birth *

Home City *

School Grade *

Home Phone Number

Email Address

Parent or Guardian Details (1)

First Name *

Relationship to Child *

Last Name *

Mobile Number

Email Address *

Parent or Guardian Details (2)

First Name

Relationship to Child

Last Name

Mobile Number

Email Address

Child Protection and Safety Information

SDBC is committed to the safety and holistic wellbeing of all children and young people involved in our events. The ensure that children and young people are kept safe from harm, our staff and volunteers are required to possess a current blue card; agree to adhere to the code of conduct when working with children; and undergo training in child safety. SDBC takes child protection and safety seriously and consequently has policies and procedures in place to ensure that your child has the best possible experience with us.

I consent to appropriate use by SDBC of photographs/videos involving my child.

Media Consent *

Yes

I consent to a leader communicating directly with my child within the SDBC child protection guidelines and social media guidelines.

Communication Consent *

Yes

I consent to my child travelling in a volunteer driver’s car within SDBC Safe transport Practice for Volunteer Drivers.

Transport Consent *

Yes

My child consents to behave in an appropriate manner as well as respecting and following the instructions of leaders.

Behaviour Consent *

Yes

Emergency Contact (must be over 18) (1)

Name *

Relationship *

Contact Number *

Emergency Contacts (must be over 18) (2)

Name

Relationship

Contact Number

Medical & Dietary

Medicare

Medicare Number

Expiry Date

Medication

If your child is taking medication during one of our events please provide it in a blister pack from the pharmacy with details of the medication, dosage and name clearly labelled. You must also fill out the medication chart (see ministry leader) and this must be completed for each event your child attends.

Is the participant on medication?

Yes

Medication name(s)

Dosage amounts and times

Does your child manage their own medication?

Yes

Dietary

Every attempt will be made to cater for each individuals dietary requirements. However, in very rare cases our cooks will not be able to cater to all your dietary needs. If this happens you will be contacted and be asked to provide more information about your allergies and may be asked to provide some additional food. Please contact us if you have any concerns.

Further Dietary Requirements

Tip: Leave blank if not applicable

Emergency Treatment

In the event of an emergency, the person in charge will follow appropriate first aid procedures, assessing whether medical intervention is required (ambulance, hospital, etc.). All necessary steps will be followed to ensure that the most appropriate action is taken. This includes:

- The person in charge of the event communicates with a parent/guardian wherever possible.

- The person in charge following recommendations from the medical form where provided.

Parents/Guardians will be responsible for any costs incurred where medical treatment is deemed necessary.

Do you consent to this? *

Yes

Confirmation of Details

The details in the Medical and General Consent Form have been confirmed in 2021

Your Details

Participant Details

Parent or Guardian Details (1)

Parent or Guardian Details (2)

Child Protection and Safety Information

Emergency Contact (must be over 18) (1)

Emergency Contacts (must be over 18) (2)

Medical & Dietary

Medicare

Medical Information

Medication

Dietary

Information

Emergency Treatment

Confirmation of Details