JRev Registration Form • The Salvation Army Rev Church

WELCOME TO JREV!

Thank you for your interest in registering your child(ren) in JRev - our kids program for toddlers to grade 5 (grade 6's welcome too!).

JRev is the kids ministry of Revolution Salisbury City, held onsite on Sunday mornings during school terms during our church services at 84 Lavender Dr, Parafield Gardens. For more general information about our program, click here to connect with us on Facebook or here to connect with us on Instagram .

High risk activities are limited to general sports activities on our ashphalt area. Group leaders is Sarah Green and team members are from our wider JRev team. All leaders are screened, checked, and trained in accordance with Salvation Army policy.

In order for us to provide the best level of care while your child is under our supervision, we require that you fill out the registration form below. This form only needs to be filled out once per family per year. The information provided below will be treated confidentially within our team.

To view information about policy about how The Salvation Army is committed to keeping your cihld safe, click here.

If you wish you make a complaint about our program, please speak to one of our team leaders or click here.

First Name *

Last Name *

Gender

Date of Birth *

School Grade *

School

Address *

Address Line 2

City *

State *

Postcode *

Language spoken at home

Is language assistance required?

Yes

Other

Medicare number

Medicare position on card

Ambulance Cover

Name and dosage of medications currently being taken

Allergies

If yes - what is their allergic response?

Tip: Please list any information to help us manage your child's allergies - medications, dietary requirements etc.

Does your child have a management plan for:

Pre-existing conditions info

Is there anything you'd like us to know about this participant or are there any relevant legal custody/orders/supervision restrictions current or pending?

Tip: eg. Physical, behavioural, cognitive, or other

Emergency Contact Name *

Email Address *

Emergency Contact Relationship *

Emergency Contact Phone Number *

Please detail the name and number of a secondary emergency contact if we are unable to reach you in case of emergency

Participant behaviour:

The behavioural expectations of the program for all participants are as follows. They agree to the following:

- I will treat everyone fairly and listen respectfully to their views

- I will not put down or bully anyone

- I will not take photos or screenshot of others during online events

- I will not use abusive and bad language

- I will not treat others differently because of their race, culture, ethnicity, gender identity, age, size, mental or physical ability

I have spoken to the participant/s named on this form to make sure they understand the behavioural expectations *

Yes

Parent/Guardian Permissions

I give permission as parent/guardian for the participant/s named on this form to take part in the overall activities of this program *

Yes

I consent to the information about the individual named on this form being collected as required for activity specific permission forms and accident/incident report forms.

I understand that in the event of an emergency we will make every effort to contact those nominated in this form. If they are uncontactable, I authorise The Salvation Army personnel to seek medical assistance, ambulance transportation and treatment for the participant as they think is necessary and agree to cover any associated costs.

Medical treatment *

Yes

Image consent and release

The Salvation Army requires specific permissions from the parent/guardian of children regarding the use of images and videos.

JRev and Rev Church are active on social media on Facebook and Instagram platforms. This consent relates to publishing images and videos of your child permanently on these platforms. Please note that if previously specified that there is a court order in relation to your child, The Salvation Army will not publish any images or videos of them in adherence to their court order.

- I acknowledge that from time to time photographs or videos may be taken as part of participating in a program at The Salvation Army.

- I understand that these images will be taken in accordance with The Salvation Army policies and procedures.

- Images may be displayed publicly. I give permission for images in which my child appears to be used by The Salvation Army for publications and public relations activities. This may include use in print and electronic media, including the Internet and official social media platforms. I have read and accept the Privacy Notice and Consent (click to view on Page 3 of this document).

- The participant will also be asked for consent to publish their image.

- I understand that no identifying information will be displayed with images.

- I understand that my consent or consent of the participant can be revoked at any time.

Photo consent *

Parent/guardian initials and date *

By entering my initials and clicking submit, I agree that:

I confirm that the information contained on this form is true and correct.

I agree to inform the leader of any change to these details.

I understand due care will be taken by The Salvation Army personnel delivering this program.

I acknowledge and agree that The Salvation Army personnel cannot be held responsible or liable for any personal injury, loss or damage sustained by my child/adult as a result of their participation in the program.

I also understand that The Salvation Army is part of the Christian church and as such will run this activity acting on those principles and beliefs.

I have read the Privacy Notice available here: The Salvation Army’s Privacy Policy

Parent/Guardian initials and date *