Pittwater Uniting Church

Christmas Eve Workshop registrations

Please take the time to fill in all details pertaining to your child/ren.

Whilst we don’t expect anything to go wrong – as every care will be taken with your children by the leaders
of the Christmas Eve Workshop – we do need you to provide emergency information in case of need.

Family details

Child 1

Child 2

Child 3

Child 4

Mother's details

Father's details

Extra contact person

Number of extra people for sausage sizzle after the performance on Dec 23:

I do not wish to be notified of Pittwater Uniting Church children’s activities in 2018

I hereby consent to the child/children listed above attending the Christmas Eve Workshop (CEW) at Pittwater Uniting Church. I authorise the leaders of CEW, where it is impracticable to communicate with me, to arrange for my child to receive such medical treatment as the leader may deem necessary at any time during the activities of CEW. I further authorise the use of an Ambulance if, in the leaders' judgement, it is necessary. I accept responsibility for payment of all expenses associated with such treatment. I appreciate that every care will be taken by the leaders of the CEW and that the leaders and those connected with that group cannot be held responsible for personal injury, loss or theft of property affecting my child. I confirm that the medical particulars given by me are correct.

I accept responsibility for the declaration above. I give permission for my child to be filmed or photographed during the Christmas Eve Workshop. I give permission for my personal details and information to be kept confidentially and used by the named church on this document.

Please fill in these 4 characters

Step 1 – submit form

By clicking "I agree" you are giving assent and permission for the above.

Step 2 – go to payment page