Mainly Music Registration Form (Please select 1 or more)

Contact person: Maggie Gibson

Event time: 10-11.30am

Date & Time

4 February, 2026 9:00 AM - 12:00 PM

Type

Quantity

Registration

Quantity

Applying discount...

Remove

Registration 0

Child

First Name *

Last Name *

Gender

Male

Female

Date of Birth *

Are there any court orders around custody of your child/children of which the church should be aware?

Yes

Any allergies we should know about?

Nuts

Fish or Shellfish

Penicillin

Milk

Soy

Sesame

Gluten (Wheat)

Fruit

Spices

Sulfates

Meat

Oats

Rice

Egg

Any illnesses for which you take medication, or any medication you need in an emergenvy?

Any other health information that you want us to know?

Do you give permission for an ambulance to be used and anaesthetic to be given by a qualified medical practitioner in an emergency when no contact person can be reached, and accept responsibility for all related expenses? *

I give permission for my photo and/or video to be used for promotional purposes. *

yes

Emergency Contact Name and Phone No *

Safe Church Policy

Gordon Baptist Church is committed to providing places, and programs that promote physical, emotional and spiritual health and safety and model the love of Christ to all with whom we have contact, particularly children, young people and vulnerable adults. For further information, see our Safe Church Policy which includes procedures for responding to concerns and complaints.

Please type your full name (Signature) *

By ticking this box, I agree that my typed name and this checkbox shall constitute my electronic signature, and that I am legally bound by the terms of this agreement. *

Tick Box

Date Sign *

Enter Parent / Guardian details here even if they will not be the Carer coming to Mainly Music.

First Name *

Last Name *

Gender

Date of Birth

Home Address

Email Address *

Phone Number *

Relationship to you

Parent / Guardian 2

First Name *

Last Name *

Gender

Male

Female

Date of Birth

Address

Email Address *

Phone Number *

Relationship to you.

Care Giver 1

Child's caregiver for Mainly Music (where this is a person other than a parent or guardian)

First Name

Last Name

Gender

Phone Number

Email Address

Relationship to the child

Care Giver 2

Child's caregiver for Mainly Music (where this is a person other than a parent or guardian)

First Name

Last Name

Gender

Phone Number

Email Address

Relationship to the child

Time Remaining