Form

Form
BURRA BURRAYACHT CLUB

6 Queen Street, Burra SA 5417ABN: 98 305 081 359Email: burra.yacht.club@gmail.com
Parental/Guardian Consent Form – Under 16 Participants

Event: Burra Burra Yacht Club – Homemade Boat Race

Date: Saturday, 15 November 2025

Location: Burra Creek, Burra SA
Participant Details*

First NameLast Name
Date Of Birth*

MonthDayYear
Date
Parent/Guardian Details*

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Consent & Acknowledgement

I, the undersigned, being the parent/guardian of the above participant:

1. Give permission for my child to participate in the Burra Burra Yacht Club Homemade Boat Race.

2. Acknowledge that while all reasonable precautions and safety measures will be taken, participation involves some risk of injury or accident.

3. Consent to first aid being administered in the event of an emergency and authorise medical treatment if required.

4. Agree to supervise my child (or nominate a responsible adult) during the event.
Grant permission for photographs/video of my child taken at the event to be used by the Burra Burra Yacht Club for promotional purposes
Parent/Guardians Signature*

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BURRA BURRAYACHT CLUB