Parent Name *

First Name

Last Name

Young Person Needing Transport Name *

If you have multiple children, please submit the form each time for each child

First Name

Last Name

Please read, understand and agree to the following: *

INVOLVEMENT CONSENT: I being the parent/guardian of the said child hereby give my consent that my son/daughter may be picked up and / or dropped home by an Authorised Youth Leader or Authorised Parent approved by Imagine Nations Church. CONNECT LEADER PHONE CONTACT CONSENT: I being the parent/guardian of the said child hereby give my consent for my son/daughter to be contacted by phone by the Authorised Youth Leader or Authorised Parent to arrange pick up and / or drop off information. I understand that the connect leader will speak to me first before speaking to my child so that I am aware of who is talking with my child. MEDICAL TREATMENT CONSENT: I being parent/guardian of the said child understand that whilst every precaution will be taken to ensure the good welfare and protection of my child, Imagine Nations Church, its staff and volunteers acting on behalf are hereby released from any and all liability in the event of any accident or misfortune, damage or loss that may occur to the child and their property. In the case of an emergency, I hereby give permission to the First Aid Staff to ensure proper treatment for my child. I understand that every effort will be made to contact me before instituting such procedures. I agree to pay all such doctor, ambulance and hospital fees incurred on behalf of my child. I have attached a list of any health information about my child that the First Aid Staff need to know. SUPERVISION POLICY: Imagine Nations Youth will provide supervision from the pick up point and / or drop off point. No child will be allowed to leave supervision until their parent/guardian is identified. It is an essential term of Imagine Nations Youth registration that where parents will not, for any reason, collect their children from the supervised drop-off point, then Imagine Nations Church, its employees, servants and volunteers as organisers of Imagine Nations Youth take no responsibility for any child leaving supervision for whatever reason. I understand and agree to be bound by this policy. In the event that the parent/s or guardian of an unaccompanied child is not at the drop off point when the child is transported, and they or the emergency contact/s be unable to be contacted, or suitable alternative arrangements made that ensures the child is appropriately supervised, Imagine Nations Church will contact the police for the ongoing safe care of the child/ren. PRIVACY POLICY: Imagine Nations Church is committed to protect the privacy of an individual’s information. Please refer to the Privacy policy on our website.

Yes - I agree