Form 3 - 2025 • Hervey Bay Baptist Church

Playgroup Enrolment Form

Details of person completing this Form

First Name *

Last Name *

Date of Birth *

Phone Number

Mobile Number *

Email Address *

Mailing Address *

Mailing City *

Mailing Postcode *

Relationship to child / children *

Tip: e.g. Parent / Grandparent / Guardian

Child/rens Details

If registering more than 4 children, please submit this form again with remaining child/ren's details. If only registering one child, leave other child details blank.

Child 1

Child's Full Name *

Child's DOB *

Child's Gender *

Female

Male

Child 3

Child 3's Full Name

Child 3's DOB

Child 3's Gender

Child 2

Child 2's Full Name

Child 2's DOB

Child 2's Gender

Female

Male

Child 4

Child 4's Full Name

Child 4's DOB

Child 4's Gender

Female

Male

Emergency & Medical

Emergency Contact Full Name *

Emergency Contact Phone *

Emergency Contact Relationship to You *

Permissions & Consent

The above information will be used to contact you regarding Playgroup and any changes to its program.

Do you give HBBC permission to use the above details for follow-up support and to receive information regarding relevant events for children, parents or carers?

Registration in our programs provides HBBC consent to take photographs or video footage of the above-named child/ren for use in internal promotions.

Do you authorise HBBC to use and publish the images for external promotions?

Correspondance Permission *

Yes

External Promotion Permission *

Yes

HBBC Policy Statement: Our Commitment

The Hervey Bay Baptist church is committed to the safety and wellbeing of all children involved in our programs. We support the rights of the child and will act without hesitation to ensure a safe child environment is maintained at all times.

We also support the rights and wellbeing of our staff and volunteers and encourage their active participation in building and maintaining a secure and safe environment for all participants.

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 Playgroup 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.

Your Privacy

The Australian Privacy Principles (APPs) set out in the Privacy Act 1988 (Cwlth) apply to Hervey Bay Baptist Church.

We collect personal information from you for the purpose of maintaining our records/database about members and affiliated people so we can provide services to you. If incomplete or inaccurate information is provided, we may not be able to provide efficient services to you.

The Privacy Act allows you to have access to and correct records of personal information held by us. If you wish to make an inquiry or complaint regarding the information we hold about you, you can contact our Ministry Facilitator who is:

Hervey Bay Baptist Church

Attention: Ministry Facilitator

Jo Lambden

20 Nikenbah-Dundowran Rd, Nikenbah, Qld 4655

joannel@hbbc.com.au

07 4124 7200

Your Agreement with Hervey Bay Baptist Church

I understand that while attending the Hervey Bay Baptist Church Playgroup program it is the Parent’s / Guardian’s responsibility to supervise the children in their care.

I understand that while 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.

Playgroup Form 3 Consent *

I accept the terms of Agreement with HBBC

Playgroup Form 3 Signed by *

Tip: Name of person completing this Form

Playgroup Form 3 Date *

2025 HBBC Playgroup

Playgroup Enrolment Form

Details of person completing this Form

Child/rens Details

Child 1

Child 3

Child 2

Child 4

Emergency & Medical

Permissions & Consent

Your Agreement with Hervey Bay Baptist Church