2024 Permission Form HPS

Child's

First Name *

Last Name *

Gender

Date of Birth

School Grade

Home Address

At St Stephen's, we welcome all young people as part of our programs, no matter their abilities and needs. We invite young people to come as they are and to grow in their love and knowledge of God, including young people who have additional needs due to physical impairment, developmental delay, mental, emotional or communication disorders and/or ongoing health challenges. We'd be glad to speak further with you about any ways we can be partnering with you to provide helpful care and support for your children - just let us know below that you'd like to speak further with a staff member.

Allergies / Relevant Medical Conditions *

Other relevent information that it would be helpful for leaders to be aware of

I would like to speak to staff member about this

Yes

Parents

Name

Email Address *

Mobile Number *

Medicare Number

I give permission for my child to attend all scheduled activities in the St Stephen's church buildings and grounds unless I advise Pippie otherwise. *

I give permission for photos and videos of my child taken at events by a designated photographer chosen by St Stepehens leaders to be displayed publicly (online and in print) unless I advise the leaders of these groups otherwise *

If I am unavailable, I authorize the program leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue, or other services that are considered necessary for my child *

Sign by Typing name