School Holiday Registration

Summer Splash Excursion

Registration Form
Event Details
Our Place is heading to Outback Splash on Wednesday, 21 January 2025!

TRANSPORT from MIDLAND YOUTH HUB to OUTBACK SPLASH

WHO: Young people aged 12-25
WHERE: Midland Youth Hub, 12 Padbury Terrace, Midland
WHEN: Arrive by 9.15am to travel by bus to Outback Splash, Bullsbrook

WHAT: Enjoy Outback Splash from 10am to 2pm
RETURN: We will return back to the Midland Youth Hub by 2.40pm

Please confirm in the form if you are travelling with us from Midland Youth Hub or meeting us at Outback Splash. If you are meeting us there, wait outside as we have pre-booked the tickets.

Food and Drinks will be provided. Please bring bathers, towel, shoes, sunscreen, a hat and a water bottle. For any questions, please contact ourplace.perth@gmail.com

If you can no longer make it to the event, please contact us so we can give your spot to someone else!
Participant Registration
This Registration is for a Young Person:*

12-1718-25
Legal Name*

First NameLast Name
Preferred Name
Pronouns*
Phone Number*
Email *
Address (required in case of an emergency)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

DayMonthYear
Date
Do you have any dietary requirements?*
Food and refreshments will be provided.
Are there any safety or risk concerns we should be aware of?*
Example: allergies, mental and/or physical conditions, swimming ability.
Transport to and from Outback Splash:*

I will be coming on the bus to and from Outback SplashI have my own transport to and from Outback Splash
Emergency Contact Details: Person 1

Emergency contact needs to be contactable
Emergency Contact Name*

First NameLast Name
Relationship To You*
Example: Parent, Guardian
Email *
Phone Number (Mobile)*
Phone Number (Other)
Emergency Contact Details: Person 2 (Optional)
Emergency Contact Name

First NameLast Name
Relationship To You
Example: Parent, Guardian
Email
Phone Number (Mobile)
Phone Number (Other)
Terms and Conditions
Transport to & from the Event

Transport to Outback Splash, Bullsbrook will be provided by means of a private chartered bus provided by the City of Swan.
Exclusion from Liability

I, the participant/parent/guardian, give permission for the staff of headspace Midland and the City of Swan to take me/my child/ren on the arranged private transport to event/activity as outlined in these Terms and Conditions.

I, the participant/parent/guardian, in the event of any accident or illness suffered by myself/my child/ren, authorise the staff of headspace Midland and the City of Swan to obtain, on my behalf, such medical assistance as I/my child/ren may so require and I agree to reimburse the organisation for any expenses incurred as a result.

I agree that the staff of headspace Midland and the City of Swan shall not be liable for any personal injury, illness or other eventuality suffered by myself/my child whilst involved in the event, or for any loss of or damage to my/my child's property during the event, howsoever caused (including but without limiting the foregoing due to or arising out of the negligence and/or breach of contract by the participating organisations, their employees or agents).
Consent

Please note, if you are under 18 years of age, a legal guardian will need to provide consent for you to attend the excursion. If you are unable to find a legal guardian, please contact headspace Midland (Casey - 0429 892 170) or the City of Swan (Erin - 0427 597 093) to discuss your options.
Acknowledgement of Terms & Conditions

By signing and submitting this Registration Form, you confirm that you have read and agree to the Terms and Conditions.
Name of Signatory*

First NameLast Name
Signature of Participant or Legal Guardian if the Participant is under the aged of 18.

Clear
Should be Empty:

Summer Splash Excursion

Event Details

Participant Registration

Emergency Contact Details: Person 1

Emergency Contact Details: Person 2 (Optional)

Terms and Conditions