Luna Ball

Luna Ball - Registration

Friday 29 November 2024 6:30pm - 9:30pm at Nhill Memorial Community Centre
This form is to register your attendance for the upcoming end of year celebration - the Luna Ball. Hindmarsh Youth Councillors have planned a fantastic evening; we can't wait to see you there!

THIS EVENT IS SMOKE, DRUG, ALCOHOL AND VAPE FREE AND IS FOR YOUNG PEOPLE AGED 12-18 YEARS.

PRIVACY STATEMENT

We will handle any personal information you have provided in this form in accordance with the Privacy and Data Protection Act 2014. Our privacy policy contains information about how you may access your personal information and seek correction of such information; as well as how to complain about a breach of the Australian Privacy Principles and how we will deal with such a complaint. For more information, please see our Privacy Policy or contact our team on (03) 5391 4444. Your personal information will not be disclosed to any other party unless Council is required to do so by law, has gained your consent to do so or an information privacy principle exemption applies.

Participant Information

Please fill out the personal information for the person/s attending this event.
Participant 1:*

First NameLast NameAge
Participant 2 (if applicable):

First NameLast NameAge
Participant 3 (if applicable):

First NameLast NameAge
Participant 4 (if applicable):

First NameLast NameAge
Do any of the participants have any dietary requirements, allergies and/or medical issues that we should know about? (We will be providing food and refreshments on the night)
Will participants be requiring a bus from Rainbow, Jeparit or Dimboola?

Yes, all participants registeredParticipant 1Participant 2Participant 3Participant 4No
Requiring the bus from: (bus departure and arrival times may different slightly)

Rainbow (5:30pm from Council office) Approx. 10:30pm arrival home.Jeparit (6:00pm from Jeparit Hall) Approx. 10:00pm arrival home.Dimboola (6:00pm from Dimboola Library) Approx. 10:00pm arrival home.
Transport registrations will close 2 days prior to the event. If you missed out please contact Hindmarsh Shire Council on 03 5391 4444 or email youth@hindmarsh.vic.go.au
PLEASE NOTE: If times change from what is stated above, our team will be in contact with you via email to let you know of new times/arrangements.

FYI: Buses will also be bringing attendees home and are expected to depart Nhill shortly after the event finishes at 9:30pm. We ask that all parents/caregivers arrive slightly before the bus is expected back to ensure no young people are left waiting on their own once getting off the bus. There will be at least one adult on all buses for supervision.

Write your song suggestions to be played on the night!
My song suggestions: *

Parental/Guardian Consent

It MUST be a parent or guardian of the child who registers.
Are you the parent/guardian of the child/ren.*

YesNo

Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email*
example@example.com
Address*

Street Address

Street Address Line 2

TownState

Post Code

Code of Conduct
In registering for this event, attendees must agree to our Code of Conduct:

You must not engage in abusive language towards a staff member, volunteer or other attendee.
You must not bring, consume or arrive at the event influenced by alcohol or drugs. Failure to comply with this requirement will result in immediate removal from the program/event.
If you are travelling to the event on Council-provided transport, loud, disruptive and unsafe behaviour will not be tolerated.
You must not engage in anti-social behaviour (fighting or the threat of violence, confrontational behaviour, bullying, exclusion).
You must not bring any dangerous items to the event, such as knives, weapons, fireworks or explosives.
You must cooperate with all staff and volunteers supervising the event and follow all directions and procedures aimed at ensuring the event is safe and enjoyable for all attendees.
Bag searches are a condition of entry.

It’s helpful to remember that you are representing your family, your school and your community. Adhering to this Code of Conduct means that the event can be safe and fun for everyone.
Do you (or your young person who is attending the event) agree to adhere to this Code of Conduct?*

Yes
Participation Release
If participant is under 18 years of age:

I hereby and forever release, discharge, indemnify and hold harmless Hindmarsh Shire Council and its employees and agents for any accidents, harm, loss or damage which my child may suffer or sustain in any way connected to the activities as a part of the Hindmarsh Shire Youth Events. I am aware that the program, in addition to usual dangers and risks inherent, has certain additional dangers and risks, some of which may include: physical exertion for which my child may not be prepared, weather extremes subject to sudden and unexpected change, remoteness to normal medical services, evacuation difficulties if my child is disabled. I authorise staff, in the event of an accident or illness, to obtain all necessary medical assistance and treatment for my child and I agree to meet whatever cost may be incurred in respect of the provision of any necessary medical services.
In the event of my child requiring medical attention I understand that the program workers will endeavour to communicate with me concerning the required action. I also agree that Hindmarsh Shire Council staff are not responsible for theft of clothing or valuables during my child’s involvement in this program. The information I have provided on this form is correct.
I have read, understood and agree to these participation release terms.
Photo Release
Hindmarsh Shire Council regularly produces photographs of people in its publications, promotional and marketing material and on its website and social media pages in order to promote community and council events, services and projects. These photographs are taken at a variety of locations and at community events, facilities and locations across the Hindmarsh and Wimmera Mallee region.
We are very grateful for your assistance, through the completion of this form. Hindmarsh Shire Council will of course, only utilise material which is enhancing to the profile of Council and the Hindmarsh region. I authorise Hindmarsh Shire Council and any person authorised by them, to reproduce, publish, broadcast or do any of the acts comprised in the copyright subsisting in;
• Photographic images
• Digital media (audio and visual)
• Production stills
• Voice recording
of me, my dependent named above and my property and to use, publish and broadcast them to reproduce, publish, broadcast or do any of the acts comprised in the copyright subsisting in;
• Any country of the world
• Conjunction with my own or a fictitious name
• In colour or otherwise
• Any medium for advertising promotion or trade
• Any altered composite or other form

I do not require inspection of the finished product or the associated wording of any copy or voiceover. I hereby release Hindmarsh Shire Council from all claims, demands, actions, proceedings, costs or expenses relating to or arising out of use of material.

This release is an ongoing commitment.
I have read, understood and agree to these photo release terms and happy for photos to be taken.I do not consent to photos being taken and/or published.
Do you have any questions or comments regarding accessibility or other event details? Please advise if there is any other important information that we need to be aware of.
I have provided all relevant / important information above for the registered participant/s
Parent/Guardian Signature (for individuals under 18 years of age):*

Clear
Should be Empty:

Luna Ball - Registration

Participant Information

Write your song suggestions to be played on the night!

Parental/Guardian Consent

Code of Conduct

Participation Release

Photo Release