Life Kids Club - Jungle QuHACKK 2026 • Life Anglican Church

Please read the Terms & Conditions here before completing this registration.

You will need to complete a registration for each child that will be attending.

Early Bird Registration - $60 Ends 31st May

Standard Registration - $70 Ends 30th June

Date & Time

7 July, 2026 9:00 AM - 10 July, 2026 1:00 PM

Type

Price

Quantity

Earlybird Ticket

Price
$60.00

Quantity

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Earlybird Ticket 0

First Name *

Last Name *

Gender *

School Year *

School *

Date of Birth *

Home Address *

Suburb *

State

Postcode

Preferred Contact Email Address

Would like to be in a group with (if possible)

Health Information

Medicare Number *

List of Regular Medication Taken

Please detail any allergies

Medical Behavioural Issues *

Asthma

Disability / Chronic Illness

Autism Spectrum Disorder (ASD)

Attention Deficit Disorder (ADD / ADHD)

Diabetes

Other

None

Medical Behavioural Details

Anaphylaxis *

Yes (food related)

Yes (non food related)

Anaphylaxis Details

Doctors Name *

Doctors Phone Number *

What other information might be helpful in caring for your child?

Parent / Guardian Information

Parent / Guardian 1 First Name *

Parent / Guardian 1 Last Name *

Parent / Guardian 1 Email *

Parent / Guardian 1 Phone *

Parent / Guardian 1 Relationship to child *

Parent / Guardian 2 First Name

Parent / Guardian 2 Last Name

Parent / Guardian 2 Email

Parent / Guardian 2 Phone

Parent / Guardian 2 Relationship to child

If you are currently attending a church, please list it below

Authority Details

List the names of any additional adults (18+) who have permission to collect your child/ren from Kids Club OTHER than the parents/guardians listed above.
We will not allow them to go home with anyone not listed as a parent/guardian or authorised adult.

Authorized Adult 1

Authorized Adult 2

Authorized Adult 3

Authorized Adult 4

Emergency Contact Name *

Tip: This will be the person we contact first, so should be the parent/guardian most accessible

Emergency Contact Relationship *

Emergency Contact Phone *

Is there anyone of concern we should NOT allow to have contact with your child?

Tip: We will not allow them to go home with anyone not listed as a parent/guardian or authorised adult.

I have read and agree to the QuHACKK 2026 Terms and Conditions.

You must read the Terms and Conditions (by clicking link above) and agree before you can continue

I agree

Total

$0.00

Time Remaining