Life Kids New Families • Life Church Townsville

First Name *

Last Name *

Gender *

Date of Birth

Throughout the year, we will be capturing photographs and videos during our services and events for promotional purposes.

Photo Permissions *

Yes - I DO give full permission for my child to be photographed/videoed during the program.

No - I do NOT grant permission

Does your child have any dietary requirements? *

Yes

No - There are NO Dietary Requirements

If Yes, please specify:

Parent's First Name *

Parent's Last Name *

Phone Number *

Email Address