Youth Indemnity Form 2021
Basic Youth Details
Youth First Name
Youth Last Name
Youth Email (Leave Blank If Same As Parent)
Youth Mobile Number (Leave Blank If Same As Parent)
Youth Date of Birth
Youth School Year in 2021
Year 6 (Term 4 Only)
Parent/Guardian #1 Name
Parent/Guardian #1 Contact Number
Parent/Guardian #1 Email
Parent/Guardian #2 Name
Parent/Guardian #2 Contact Number
Parent/Guardian #2 Email
Emergency Contact Number
Please Select Relevant Medical Conditions
Allergic to Penicillin
Allergic to Bees/Wasps
ASD (Autism Spectrum Disorder)
Behavioural Condition (Please Note Below)
Please Select Relevant Dietary Conditions
Allergic to Nuts
Intolerance to Gluten
Allergic/Intolerant to Lactose
Allergic/Intolerant to Dairy
Ambulance Member Number (If Relevant)
Medicare Number (If Relevant)
HealthCare Number (If Relevant)
Private Health Number (If Relevant)
Are there any Conditions/Personal Needs for your child that you would like us to know about?
Regular Medication being taken.
Are there Court-Ordered Custody Agreements in place for this child?
Do you give permission for your child to be photographed/recorded during the course of Follow Youth events?
Do you give permission for your child's image or video to be used in promotional material for Follow Baptist Church or Follow Youth?
Do you give permission for your child to be driven to/from activities by Follow Baptist Church Leaders?
Do you give permission for your child to receive food/drink for special events?
By filling in this form and typing my name below, I signify that I consent my child in participating in the Follow Youth program provided by Follow Baptist Church. I will encourage my child to be respectful and cooperative with all Youth, Leaders and Staff.
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