Activity permission slip

Event name*

Date*

Particpant Details:

Name:*

Home Address:*

Phone Number:*

Date of Birth:*

Medicare card number:*

I understand that:

· Corryong Youth Space activities are co-ordinated by the Corryong Neighbourhood Centre workers and volunteers in accordance with CNC code of conduct and policies, but that participants may not be continuously supervised during activities and event and are required to take responsibility for their own behaviour.

· Inappropriate behaviour or language which impacts on the success of the activity, the enjoyment of other participants or the reputation of the CNC will not be tolerated. Participants who behave or speak inappropriately will be removed from the activity and may be required to arrange immediate transportation home or barred from participation in future events.

· All care will be taken, but accidents happen. Participants will receive appropriate medical treatment if this should occur and need to be able to provide Medicare/medical details if required. (For minors, parent or guardian will be contacted as soon as possible if an incident occurs).

· This event may require travel which will generally be undertaken by either CNC owned car or bus, but may involve use of other private vehicles. Any vehicles used will be covered by comprehensive insurance. At the end of the trip home, participants are required to assist for 5-10 minutes to remove rubbish, clean out vehicles and put equipment away.

· Participants can be picked up or dropped off only directly ON THE WAY to or from activities and at a place and time previously arranged by the organiser. Unless otherwise arranged, all activities will commence and end at the CNC, 39 Hanson St, Corryong. Organisers and transport will not wait for participants who are not at appointed collection and drop points at the advised times.

· We expect all participants to carry a charged mobile phone or other device which enables them to communicate with the activity organisers and their parent/guardian/emergency contact during the activity. Any participant who is unable to meet this expectation, must advise the organiser at the start of the activity to ensure alternative communication arrangements are established.

· Any additional restrictions or requirements relevant to this activity are listed on the reverse

Participants may be photographed or filmed during events and activities for use in media, promotion or other publicity by the CNC or other activity operators. If participants do not wish to be included, they need to advise accordingly by ticking below.

Participants Signature (all ages):*

Parent/Guardian signature (if U18) - I hereby give permission for the participant to take part in this activity:

Parent or guardian name:

Emergency contact - name & number (if different to above)

Please add any additional requirements or comments below if applicable such as dietary requirements or allergies.