2015
Form 3
KEEP this page for your reference.
Welcome to Playtime 2015.
In order to maintain our high standard of care and safety for all those involved in our Playtime program, we ask for
your assistance in keeping our database information current by completing the attached Enrolment Form. We
understand how busy life can be and so appreciate your willingness to provide us with the information requested.
Please complete pages 2 & 3 and hand to the Playtime Leader.
We look forward to connecting with your family during the year. Do not hesitate to contact us if you have any
questions.
Thank you for joining us at Playtime.
Key Information
In order to provide the highest level of care for the children under 18 in our programs, HBBC has implemented a Risk
Management Strategy. Our Risk Management policy and procedures are available on request.
In terms of our Policy, our leaders hold current Blue Cards, as required by law, but also are given input and ongoing training in
how to effectively and appropriately work with children under 18. We expect all our leaders to display healthy Christian principles
and values in their leadership and relationships.
Whilst attending the Hervey Bay Baptist Church Playtime program it is the Parent’s responsibility to supervise the children in their
care.
It is your responsibility to ensure that the information supplied on this enrolment form remains current at all times. Any changes
need to be in writing and forwarded to the Church office.
Parents / guardians are welcome to observe the operations of our children and youth programs.
Protecting your privacy is important to us. The information we seek allows us to manage risk, provide reasonable care and administer your
child/ren’s involvement in our program. We are careful to keep your information confidential, and provide it only to those acting on behalf of
HBBC who need it to enable them to perform their agreed activities (e.g. the First-Aider-In-Charge). Information supplied to us is stored on the
data base of the HBBC with password access to HBBC staff only and in a locked filing cabinet with access to HBBC staff only.
You are welcome to contact our office in relation to issues regarding your personal information and for a copy of our Privacy Policy. We only ask
for information that is necessary for the purposes outlined in this statement. In some circumstances, if you don't provide us with the requested
information, your child/ren may miss out on the opportunity to be involved in our programs.
Web: www.hbbc.com.au
Phone: 4124 7200
Email: office@hbbc.com.au
Bus Hotline: 4124 8592
G:\HBBC Governance\Forms Register\Form 3_Under 18 Playtime Enrolment Form 2015 Web.docx
PO Box 854 Hervey Bay 4655
20 Nikenbah Dundowran Rd, Nikenbah
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2015
Form 3
Hervey Bay Baptist Church
Playtime - Family Enrolment Form
We ask all parents who attend the HBBC Playtime program to complete this enrolment form.
Family Contact Details
Family Surname(s) _____________________________________________________________
Parent Given Name: Mother ______________________ Father ______________________
Guardian / Carer: Full Name __________________________________________________
Address ________________________________ Suburb ____________________ Pcode_______
Postal Address ___________________________ Suburb ____________________ Pcode_______
Home Phone ________________________ Work Phone ________________________
Mobile 1 ___________________________ Mobile 2 ______________________________
Email Address ________________________________________________________________
Please provide the following information for each child attending Playtime
Given Name
Surname
Gender
DOB
_____________________
_________________________
 Male  Female
_______________
_____________________
_________________________
 Male  Female
_______________
_____________________
_________________________
 Male  Female
_______________
_____________________
_________________________
 Male  Female
_______________
_____________________
_________________________
 Male  Female
_______________
_____________________
_________________________
 Male  Female
_______________
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2015
Form 3
We appreciate the opportunity to be able to contact you for the purpose of care, follow-up and informing
you of coming events and changes.
Do you give permission for HBBC to use the above information for this purpose?
Yes / No
Do you give permission for HBBC to use and reproduce appropriate photographic/video/ film/digital images
of the above named children for the purposes of
External promotional material - Yes / No
Your Agreement with Hervey Bay Baptist Church
I consent to the use of the above information for the purposes of compiling and maintaining the Hervey Bay Baptist
Church’s records, rolls and registers.
I agree that the material provided may be used for the purposes of the Hervey Bay Baptist Church without further
consent or permission from me. I acknowledge that this consent form will remain current while I attend the Hervey
Bay Baptist Church, unless I revoke it in writing.
I understand that whilst attending the Hervey Bay Baptist Church Playtime program it is the Parent’s / Guardian’s
responsibility to supervise the children in their care.
I understand that whilst the Hervey Bay Baptist Church is committed to providing a safe environment and will make
every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities
cannot be foreseen or may be beyond the control of the Hervey Bay Baptist Church, its leaders and staff.
__________________________
Name of Parent / Guardian
__________________________
Signature
___________
Date
If other than a parent or guardian, please indicate relationship to child: ______________________
Please RETURN pages 2 & 3 to The Hervey Bay Baptist Church
Please KEEP page 1 for your reference
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