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Youth Activity Consent Form

Community

Required fields are marked with an asterisk (*).
Consent Form
Emergency Contacts
Relevant Medical Details
Does your child suffer from any of the following Medical Conditions? *
In the case of any incident involving my child, I hereby give staff permission to seek medical treatment for my child, and I agree to cover the full cost of any treatment needed. *
Behaviour
Transport
I accept that this event/activity may be conducted at venues outside of the Circular Head area and give permission for my child to be transported to/from such venues. I have read, understood and agree to the conditions as stated. *
Any additional information
Parent/Guardian's Consent/Release
I confirm that I am the parent/guardian of the person registered on this form. *
I give consent for my child to take part in the program, excursions and activities. *
I understand that although the Circular Head Council and its service providers attempt to minimize any risk of personal injury within practical boundaries, accidents do happen and all physical activities carry the risk of personal injury. I acknowledge that there are inherent risks of personal injury involved in this Circular Head Council program/event/activity and I agree that my child participates in activities at his/her own risk. *
I agree that neither the Circular Head Council nor its officers or servants are liable for any damage or injury that may be incurred by my child attending this program/event/activity any of the activities in connection with the programs, including excursions or camps. *
I authorize staff in the event of any illness or accident to obtain on my behalf any medical assistance as my child person may require which may include injection, anaesthetics and/or blood transfusions. In case of emergency I agree for my child to be transported by Ambulance, Council motor vehicle or in extreme emergency worker private motor vehicle. *
In the event of my child behaving irresponsibly and/or not complying with safety rules, I agree to immediately collect my child from the program, excursion or camp or to reimburse Council for any costs involved in the return of my child from the program. *
I also agree to supply my child with all necessary medication (e.g. asthma puffer). I understand that my child will not be allowed to attend the excursion/activity unless all medication has been supplied. *
I understand that staff cannot administer medication to my child without my written consent. *
I understand and accept that it is my responsibility to advise Council staff of any changes to the information supplied (including medical). *
I consent to the Circular Head Council using and endorsing the use of photographs/video footage of my child taken whilst participating in the Circular Head Council program/event/activity for publicity and promotional purposes. I am aware that photographs/video footage may be used in leaflets, brochures, newspapers and/or on the internet. *
You will receive a confirmation email to this address. Please respond to the confirmation email to prove your identity.