Child Enrolment Form 2026 • Port City Christian Church

Enrolment Form

About Your Child

First Name *

Last Name *

Date of Birth *

Gender *

School Grade

Mailing Address

Mailing Postcode

Medical & Custody Information

Do any of the following apply to your child?

Please select all Medical Conditions that apply:

Please select all Behavioural/Mental Health Conditions that apply:

Please select which Custody Arrangement applies:

Please select all Allergies that apply:

Please select all Dietary Requirements that apply:

Please provide relevant details for any listed conditions

Parent/Guardian Information

Parent/Guardian 1 - Full Name *

Parent/Guardian 1 - Relationship to Child

Parent/Guardian 1 - Mobile Number *

Parent/Guardian 1 - Email *

__________________________________________

Parent/Guardian 2 - Full Name

Parent/Guardian 2 - Relationship to Child

Parent/Guardian 2 - Mobile Number

Parent/Guardian 2 - Email

Consent

Please read the Child/Youth Program Consent information

I have read the conditions and I give permission for my child to:

Participate in the Program *

Yes

Recieve Medical Treatment if Required *

Yes

Sign themselves out at the end of the program *

Yes

Contact Consent *

Yes

Photo and Media Consent *

Yes

Communication & Care

Email Communications I would like to receive *

Children's Church (e.g. Term Plan, Memory Verses, End of Year celebration notification, Sign-in process changes)

Upcoming Events (e.g. visiting preachers, Christmas play)

General Church Mailing List

If you are looking for further information, how can we help?

I would like to receive a phone call from a Port City Church team member

I would like to receive information via email about ways to connect at Port City Church

I would like to receive information via email about Port City Church's Statement of Faith