JY Australia | Parental Consent Form

Verify your email to register

or use a secure email link

Parent / Guardian Details

Full name *

Required

Email address *

Verified parent or guardian email

Required

Second parent/guardian (optional)

If supplied, this email can access the child's details. Enter it twice carefully.

Second parent emails must match

Phone number *

Required

Residential address *

Required

State *

Required

Prayer group (optional)

Required

Child / Young Person's Details

Full name *

Required

Date of birth *

Required

Emergency Contact

Primary contact full name *

Required

Primary contact number *

Required

Secondary contact full name *

Required

Secondary contact number *

Required

Authorised Collectors

Who is authorised to collect your child?

Only listed people can sign your child out. Add at least one.

Add at least one authorised collector

Health

Any allergies? *

Required

Any phobias, medical conditions or disabilities? *

Required

Details of any medications (ensure adequate supply is brought to events and given to an organiser) *

Required

Do you agree to emergency treatment being given to your child, including emergency transport, as considered necessary? *

I DO — agree to emergency treatment if required I DO NOT — agree to emergency treatment

Please select one option

Declaration

I understand that my child must not:

Possess or consume alcohol or other drugs at the event
Smoke tobacco or other substances at the event
Risk the health and safety of workers or other participants on the program by their actions
Use offensive or abusive language directed towards program participants, workers or anyone who comes in contact with the program
Leave the premises without an authorised adult

I understand that participation is conditional on fulfilling these conditions, and that breach is grounds for exclusion.

I have read and agree to the declaration above

Please acknowledge the declaration

Consent

Please select *

I Accept I Do Not Accept

Photography & video permission *

If you do not give permission for your child's photo to be published, please make sure your child is aware of this.

Yes — I grant permission for photography/video No — I do not give photo/video permission

Please select one option

📋 Privacy Collection Statement Jesus Youth Australia collects personal information (including your child's name, date of birth, medical details and emergency contacts) for the purpose of providing and managing the JY Australia child safeguarding program.

This information is stored securely and accessed only by authorised Safeguarding Officers. It will not be disclosed to third parties except as required by law or for the safety of your child. You have the right to access or correct your information at any time by contacting your state Safeguarding Officer.

Collection is authorised under the Australian Privacy Act 1988 and applicable state child protection legislation.

I have read and understood the Privacy Collection Statement above *

Please acknowledge the privacy statement

Review & Submit

What would you like to do?

🎉

Registration submitted!

The following children have been registered and are pending Officer review.

Once the Officer approves your registration, sign in to JY Australia using:
📧 Your registered email
The Officer may contact you at if clarification is needed.

Return to app

Register your child

Verify your email to register

Registration submitted!