Rockingham Church - Ministry/Program/Event Application to Proceed • Deo Gloria Community Church Rockingham

Application to proceed with Ministry/Program/Event

This application form shall be completed by all leaders that are running or planning to run a ministry/program/event through our church.

Ministry/Program/Event: *

Location: *

Date and Time: *

Ministry Leader Name: *

Contact Number: *

Email Address *

First Aid Officer:

Supervision Ratio: *

Working with Children Check

All people aged 18 years or older and working with children are required to have a Working with Children's Check Number (WWCC).

Please insure yourself and the volunteers in your program who work with children complete an application form (available at AusPost.)

Please email us a copy of your current WWCC to the Safeguarding email address at deogloriaoffice@gmail.com

Do your ministry require you to work with children? *

Do the leader's and volunteers in your group work with children? *

For emergencies contact 000

Event Leadership Details:

Please list the name and contact number for all leader's and volunteers for this ministry/program/event: *

Program Overview/Running Sheet:

Please give us a brief overview of the program/event or ministry that you are applying for:

Program Overview *

Risk Assessment:

Physical /Environment:

(e.g. roads, car park area, steps and stairs, uneven surfaces, windows, balconies, landings, gates and doors, walls and fences, low ceilings, cupboards that are high to reach or that are very low, slippery floors, ponds, rivers, canals, possible asbestos, hazardous litter, seasonal changes to physical environment)

Potential Hazards: *

Who is at risk? *

Existing control measures: (Eg: All kids are in building and not leaving the premises, the risk of injury is very low) *

Risk Rating *

Preventative Measures: (Eg. Always have two adults in kids room for safety and back up) *

Responsibilities: (Eg. Ministry leader, event leader and helper) *

Activities:

(e.g. indoor and outdoor activities, messy activities, active movement, cleaning and cooking, transport,activities involving water, heavy lifting, leaving your usual venue to go on a trip or receiving visitors)

Potential Hazards: *

Who is at risk? *

Existing control measures: *

Risk Rating *

Preventative Measures: *

Responsibilities *

Equipment:

(e.g. children's large play or climbing equipment, children's toys, office equipment, electrical equipment,)

Potential Hazards: *

Who is at risk? *

Existing control measures: *

Risk Rating: *

Preventative Measures: *

Responsibilities *

Comments/Action Required

Please list comments and action required below *

Approval requested by:

Applicant's Name: *

Position/Role: *

Date: *

Signed: (Printed name will be sufficient) *