Pupil Free Monday • Stanhope Anglican Church

Date & Time

21 July, 2025 9:00 AM - 3:00 PM

Type

Price

Quantity

Child Registration

Price
$15.00

Quantity

Child Registration 0

Where and When:

Stanhope Anglican Church - 1 View Street, Stanhope Gardens
Monday 21st July from 9am–3pm
Please sign in your child(ren) at the front desk upon arrival, and sign them out when picking them up.

Ticket Price: $15

Ticket price includes morning tea and lunch (please indicate in the form any dietary requirements your child may have).

Payment Options (in order of preference):

Credit card (preferred): Use our secure PayPal gateway. No PayPal account is required, just choose [Pay with a Card] on the PayPal page
Electronic Funds Transfer: Bank account details provided by email upon registration.
Cash upon arrival

For further information please contact:

Jeremy Smith: 0425 398 092 - jeremy@stanhopechurch.org.au

Parent/Guardian Details

Primary Contact

Emergency Contact

First Name *

Last Name *

Mobile Number *

Email Address *

Home Address *

Home Suburb *

Home Postcode *

Will you be the authorised person to collect the child? *

Yes

No please specify

Authorised Person to collect (name and number) *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Mobile *

Relationship to child

Child Details

First Name *

Last Name *

Preferred Name

Does you child have any allergies or dietary requirements? *

Please select from the drop-down list: *

Other allergies: *

Does my child have an Anaphylaxis Plan? *

Date of Birth *

Gender *

School Year (current) *

School Attending

Permissions, Authorisations, and Expectations

By completing this form, I hereby give permission for my child to attend all scheduled Stanhope Pupil Free Monday activities, unless I explicitly advise the leaders otherwise.
I give permission for the personal details given herein to appropriate Stanhope Pupil Free Monday leaders and/or relevant supervisory/medical/emergency services personnel as deemed necessary.
I acknowledge that in the course of Stanhope Pupil Free Monday activities, appropriate photos/videos may be taken of my child by authorised personnel and may be displayed for internal and/or online use, unless I explicitly advise otherwise.
I understand the details given herein will be used by Stanhope Pupil Free Monday leaders to contact myself, and that the details will not be given to any third party except as provided for above purposes.
I acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my chid being sent home and/or being temporarily or permanently prohibited from attending Stanhope Pupil Free Monday.
I understand that every effort will be made to provide a safe environment for my child to participate in. However, in signing this form, I authorise the leaders of Stanhope Pupil Free Monday, in the event of an emegency, to obtain at my expense, any medical, ambulance, rescue or other service considered necessary.
I will provide the leaders of Stanhope Pupil Free Monday with any information relevant to the wellbeing of my child prior to him or her attending. This might include supporting documentation (such as an AVO, Family Court Order) if there is anyone who is legally restricted from seeing my child.
I understand Stanhope Pupil Free Monday will include Christian based teaching and content.
I confirm that the information given in this form is true and correct, and will advise the leaders of Stanhope Pupil Free Monday of any changes to this information.

Please tick: *

Yes, I agree to the above statements, declarations, authorisations, and expectations for the child in this form.

Signature of Parent/Guardian

Parent/Guardian Full Name *

Date *

Any other comments?