Youth ART Workshop

Youth ART Registration Form

Parent/Carer Permission Form
Under 18 Parental/Guardian Consent form

As part of our Policies and Procedures, any student under 18 is considered a minor and will require parental consent to attend programs/meetings and events.

Please complete the form below to help us manage risk, provide reasonable care, and administer your child’s involvement.

The information we collect is kept confidential and only provided to those involved in the activities (eg. First Aid, Coaches, Instructors).
Participants Name*

First NameSurname
Date of Birth*

DayMonthYear
Date of
Age*
Gender*
School/College if applicable*
Year*
Participant's mobile *
Parent/Guardian Name*
Relationship to Child (mother,father,guardian)*
Address*
Parent/Guardian Mobile No.*
Parent/Guardian Email*
example@example.com
Do you identify as Aboriginal and/or Torres Strait Islander?*

AboriginalTorres Strait IslanderNeither
EMERGENCY/AUTHORISED PERSON IF WE ARE UNABLE TO CONTACT PARENT/GUARDIAN
Name
Relationship to Child
Mobile No
MEDICAL INFORMATION
Participants Medicare Number
Will the participant need to take any medication during the art session?*

YesNo
If medication is required, please specify times
Please list any allergies/food intolerance/dietary requirements
Please list any relevant medical/physical conditions.
Please list any developmental needs (Learning or cognitive impairment, ASD etc)
I permit photographs/videos to be taken and used for promotional and social media purposes. No names will be used. Participants will also get to choose what photos/videos of themselves are published.*

YesNo
CONSENT*

In the event of a medical emergency, I hereby authorise the staff to act on my behalf to seek medical attention for my child and agree to meet any expenses incurred.If I have advised the facilitators beforehand, I permit my child to leave the venue on their own or with friends.
Parent/Guardian Signature*
Date*

DayMonthYear
Date
Any Further Comments
If you have any questions, please email Sarah on info@kidsinthevalley.com.au
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Youth ART Registration Form

EMERGENCY/AUTHORISED PERSON IF WE ARE UNABLE TO CONTACT PARENT/GUARDIAN