Participant Consent Form

Event Details:

Date: Saturday, May 24, 2025

Purpose of the Activity: The Great Canoe Race

Location: Fig Tree Pocket Boat Ramp and Long Pocket Boat Ramp

Activities to be undertaken: Canoe and Kayaking on the Brisbane River

Cost: $3 per Racer

Participant Name

First NameLast Name

Company

Consent*

I have provided The Boys' Brigade Qld with all current information relating to the above named participant including any special medical management details; details of all known allergies (drugs, foods, insects etc) and allergic reaction management forms; details of recent operations or injuries; details of current prescription medication and administraton and any special diary requirements. I will also ensure he has sufficient medications (if required) for the duration of the activity. Any changes to the medical information currently held by the group - particularly recent sicknesses or injuries or changes in medication - MUST be advised on a supplementary medical form).

Are there any changes to the information currently held?*

YesNo

I am aware that this activity may be challenging both physically and emotionally and realise that, in spite of the planning processes of the group, members may experience situations where they encounter unpredictable and unforseen risks and acknowledge, despite precautions and supervision, accidents may happen.*

Yes

In addition I DO / DO NOT (please choose below) give my consent for myself / my child to appear in any photograph, video or sound recording produced during this activity which may be used by The Boys’ Brigade Queensland for promotional purposes.*

I DOI DO NOT

I give my permission for the participant to attend and take part in the activities or event described above. I understand that in the event of any illness or accident, every effort will be made to contact me, but if this is not possible, I authorise any Leader to sign on my behalf, any written form of consent required by medical providers (including the administration of anesthetic if required) and accept all associated costs.[I understand that the information collected on this form will be used for the purposes of fulfilling the Boys’ Brigade Australia’s objectives and duty of care for my child and will be treated securely and not be passed on for commercial purposes.]*

Yes

Parent Name

First NameLast Name

Relationship to participant

Emergency Contact Number

Please enter a valid phone number.

Signature