Little Town Jnr Cast U18 Registration • St Peter's Lutheran Church Loxton

Little Town Junior Cast Registration Form (Under 18)

We are looking forward to having your child join in the activities we have planned.

In order for us to provide the best level of care while your child is under our supervision, we require that you fill out the registration form below.

This form needs to be filled out once per child.

The information provided below will be treated confidentially within our team.

Thanks again!

Little Town Junior - Nativity 1.0 Production Team

Audition and Role Information (for your child to answer)

Which part you would like to audition for (if known):

Are you interested in assisting with Tech?

Are there any dates between now and the performance you know you will be absent for?

Would your parent(s) be willing to help in any way?

Child's Details

First Name *

Last Name *

Date of Birth *

Gender *

Mobile Number

Home Address *

Home City *

Home State *

Home Postcode *

Safety and Care Details

In the case of an emergency, please list the phone numbers where you and another trusted adult may be contacted during the course of the program.

Primary Caregiver's Details

Primary Caregiver's Name *

Relationship to the Child *

Primary Caregiver's Mobile *

Email Address *

Secondary Emergency Contact Details

Secondary Contact Name *

Secondary Contact Relationship to Child *

Scondary Contact Mobile *

Medical Information

Are there any medical or psychological conditions which require special attention that we should know about e.g. diabetes, asthma, allergy to bee-sting, other allergies including food, hearing or sight impairment, ADHD, behaviour issues, formal counselling situations, or any other? Please Note: If needed to care for your child best, we may ask you to complete a more comprehensive Child Medical Information Form.

Please list below:

Medical Information

Pick up Details

Who will collect your child(ren) at the end of the program? Please nominate either yourself or another trusted adult (and let us know if this changes throughout the year):

Pickup Person Details *

Your Agreement With Us

I understand that although the leaders will take all reasonable care to ensure both the comfort and safety of my child, there is still a risk that an accident may occur.

I AGREE TO MY CHILD BEING PART OF LITTLE TOWN JR REHEARSALS AND PERFORMANCES 2025:

Yes

I UNDERSTAND LITTLE TOWN JR WILL BE PHOTOGRAPHED AND FILMED, AND GIVE MY PERMISSION FOR IMAGES OF MY CHILD TO BE RECORDED FOR FUTURE PROMOTIONAL AND RECORDING REASONS:

Yes

The Directing Team (Cheryl, Jordan, Laura, Karyn and Jenni) will allocate roles straight after the auditions have finished and will then post the cast list to the LITTLE TOWN JR WHATSAPP Group.

Primary Caregiver's Name *

I understand my agreement with the program organiser *

Yes

Date *