2024 Flinders Council School Holiday Program Permissions Form

2024 School Holiday Program Permissions Form
Childs Details
Child's Name*

Childs First NameChilds Last Name
Childs Birth Date*

DayMonthYear
School Grade*
MaleFemaleNon-binaryPrefer not to respondOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information
Parents/Guardians Name*

Parents First NameParents Last Name
Relationship with child*
Parent/Guardians Mobile Number*
Home Number
Parent/Guardians E-mail*
please note: we will be adding your email to a mailing distribution list.
Yes
Parent/Guardians Name*

First NameLast Name
Relationship with child*
Parent/Guardians Mobile Number*
Home Number
Parent/Guardians E-mail*
please note: we will be adding your email to a mailing distribution list.
Emergency Contact
Emergency Contact's Name*

First NameLast Name
Relationship with child*
Emergency Contants Phone Number*
Alt. Phone Number

Medical Information
Does the Child have any allergies, chronic illness, or medical conditions? If yes, please describe if nothing please write 'Nil'.*
Is there any other information you think we should know?*

Movie and Computer Games Classification Permission for 2024
G ratedPG ratedM ratedMA 15+ rated
Movie Classifications:

General (G)
The content is very mild in impact
The G classification is suitable for everyone. G products may contain classifiable elements such as language and themes that are very mild in impact.

Parental Guidance (PG)
The content is mild in impact
The impact of PG (Parental Guidance) classified films and computer games should be no higher than mild, but they may contain content that children find confusing or upsetting and may require the guidance of parents, teachers or guardians. For example, they may contain classifiable elements such as language and themes that are mild in impact.

PG-rated content is not recommended for viewing by people under the age of 15 without guidance from parents, teachers or guardians.

Mature (M)
The content is moderate in impact
Films and computer games classified M (Mature) contain content of a moderate impact. M-rated films and computer games are not recommended for children under the age of 15. They include portrayals of elements such as violence and themes that require a mature outlook.

However, children under the age of 15 may legally access this material as the classification rating is an advisory category.

Parents, teachers and guardians may need to find out more about the specific content before deciding whether the material is suitable for children in their care.

Parental Authorisation & Indemity Form

The following Indemnity Form, if signed, gives your consent for your child/children to participate in all excursions, sports, and other activities
organised by the officers of Flinders Council.
1. I hereby give permission for my child/children to participate, under the supervision of Flinders Council staff, in all 2024 School Holiday Program activities and excursions organised by Flinders Council.
2. I hereby declare that I shall not hold the aforementioned Flinders Council or its bona-fide representatives liable for any damage or injury sustained by my child/children while he/she is on an excursion, or activity.
3. I also undertake to indemnify the bona-fide representatives of Flinders Council against all claims by me, or any third parties, arising from any cause or action whatsoever, and will not hold Flinders Council or its representatives liable for any injury or loss or any damages consequent there to, sustained whilst my child/children is in their care.
4. I accept that the staff of Flinders Council and their designated assistants will take every reasonable precaution to ensure the safety of my child/children.
5. It is understood that in the event of an emergency situation, the judgment of the staff of Flinders Council will prevail. In case of emergency, and I cannot be reached, I give my consent to allow my child/children to be treated by a physician or at a medical facility.
Parent/Guardians Name*

First NameLast Name
Relationship to child*
Confirmation

By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
Signature*

Clear
Date

DayMonthYear
Date

Media Permission Form
I GIVE PERMISSION
On behalf of the Participant (person/s in the image)/Copyright Owner (photographer), the person signing this Publication Permission Form grants permission to Flinders Council to use and/or retain the Participant’s image.

FOR THE PURPOSE OF
Public relations, promotion and/or advertising use on the Flinders Council website, print media and social media sites.

FOR THE DURATION OF
The permission will continue until the Participant/Copyright Owner or Signatory revokes permission. The Participant/Copyright Owner or Signatory can withdraw or modify their consent at any time by writing to the Community Development Officer, Flinders Council.

ACKNOWLEDGEMENT AND CONSENT
1. I understand that ‘use’ includes:
  • to distribute, publish or communicate in any form via the internet and print media.
2. I acknowledge, agree and consent that I (the Signatory) and the Participant/Copyright Owner:
  • have no right of pre-approval with respect to the Images;
  • have no right of veto with respect to the Images.
3. I understand that Flinders Council will not pay the Signatory or Participant/Copyright Owner for my giving this permission or for the use of the Participant’s Image.
4. Flinders Council is not liable to, and is released from any liability to, the Participant/Copyright Owner or the Signatory, for any use which may be made of the Images.
5. Flinders Council will destroy Images if the Participant or Signatory withdraws consent, with the exception of those already published.
6. Flinders Council undertakes that any personal information collected on this form, or as a consequence of this form, will be kept only for Council records and will not be released to any other individual or organisation.
Childs Name*

First NameLast Name
YES, I agree to the Terms and conditions to this Media ReleaseNO, I don't agree. Please don't publish photos of the participant.
Confirmation

By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
Signature*

Clear
Date

DayMonthYear
Date

Ideas and suggestions
Do you or your children have any suggestions for future School Holiday Programs? Or would you like to volunteer occasionally or for a specific activity?
Should be Empty:

2024 School Holiday Program Permissions Form

Childs Details

Parent/Guardian Information

Emergency Contact

Medical Information

Movie and Computer Games Classification Permission for 2024

Media Permission Form

Ideas and suggestions