New Person Registration form

FRIDAY NIGHTS RUN EVERY FRIDAY DURING THE SCHOOL TERM

7PM - 9PM

1 SIMEON RD, ORCHARD HILLS NSW 2748 AUSTRALIA

INY. is led by Youth Pastors, Matt & Asha Rau. All our services are fully supervised by trained youth leaders and our venue is drug and alcohol free.

If you would like more information please contact our Youth Office on 4736 3000.

INY is committed to upholding the Child Safe Standards. All INY team members over 18 hold a verified and current WWCC# and all team are trained in Safe Church ministry and agree to a Code of Conduct. The safety of your young person is extremely important to us. To read our Child Protection Policy Information for Parents click here, for Young People click here

If you ever have a concern for the safety or wellbeing your child, another person’s child, or the actions of one of our team, or anyone else, please contact our safer churches officer, Ps Allyson Parker on 4736 3000, or use the contact form here:

Safer Churches Form - Youth Site

Details of person who has raised the concerns/received the disclosure

Name

First Name

Last Name

Contact Details

Role

Relationship with the child/person whom the report is about

Details of the person whom the concern / disclosure is about

Full Name

Age and DOB

Gender

School (if applicable)

Any other relevant details or issues to be aware of (e.g. cultural issue, disability, ethnicity, etc)

Who does the person live with (include address and contact details)

Is the person aware of this report?

Is the parent/ guardian aware of this report? (Where applicable)

Where is the person now? Is s/he in a place of safety and are there any immediate medical issues?

The Concern

Child Protection Concern

Observed/suspected by yourself

Disclosure by the person

Allegation made by:

Fill info below if you clicked "Allegation made by"

Full Name

Address

Contact Number

Details of person subject of the allegation/information

Who is the person subject of the allegation/information?

Church Staff

Church Volunteer/Leader

Family Member of child

Member of Congregation

Someone in the community

Name of person subject of the allegation/information

Age and DOB (if known)

Address (if known)

Contact Number (if known)

Other relevant details e.g. job position, relationship with child, etc (if known)

Details of Report

Please include the following: • Details of the child protection concern or incident (Include what is alleged to have happened? What were the circumstances etc) • Write down exactly what the child or other person has said (in his/her own words) and what you said (NB: Do not ask the child leading question - record actual details) • Observations made by you (e.g. observed injures, persons perceived emotional state etc. Mark which observations are fact or opinion)

Date(s), Time(s) of incident(s)

Location(s) of incident (if known)

Information/Allegation Details

Imagine Nations Church will fulfil all reporting obligations according to National and State legislation including mandatory reports to the Department of Communities and Justice, police or other government statutory authorities. It is an offense to provide false or misleading information.