Date: 17th - 20th Jan 2018

In submitting this form, I acknowledge that I am giving permission for my child/ren to attend the Pennant Hills Baptist Church's Pennolife program to be held at Pennant Hills Baptist Church (Years 3-6 program may also be held at Pennant Hills Primary School and St Mark's Anglican Church) on 17th Jan - 20th Jan 2018.

I understand that:

• Supervision for my child/ren is not provided before or after the program hours of 9:30am - 12pm

• Photos taken of individual children will not be circulated outside the church without express parental consent.

• Please note that parent/guardian will need to stay with children in the Bubbles/Preschool Group at all times unless discussed with the Group Leader

• All information gathered from registration will remain confidential and solely with the Pennolife leaders and the church, utilised only for the purposes of showing care to children and keeping families up to date with future events. This information will not be given or sold to any 3rd party.

Details of Parent(s)/Guardian(s)

Tip: Please enter number with no spaces (eg. 04XXXXXXXX)

Emergency Contact Details

Emergency Contact 1

Tip: Please enter number with no spaces (eg. 04XXXXXXXX)

Emergency Contact 2

Details of Child/ren

Child 1

Child 2

Child 3

Child 4

Medical, Dietary and Allergy Information

Optional Details

Tip: Fill in Yes/No or N/A

Number of children & adults coming for Saturday Family Fun Day