Youth Zone Parent Consent Form

YOUTH ZONE PARENTS CONSENT FORM
The Shire of Nannup has partnered with Hive Mind Sport Solutions to deliver engaging activities focused on sport, wellbeing, and leadership.

The Youth Zone is a dedicated space for young people aged 11 to 15 years. It is designed to provide a safe and supportive environment where participants can relax, connect with others, and take part in activities and equipment that reflect their interests. Attendance at Youth Zone requires a level of maturity and trust in the young people who attend.

The space is supervised at all times by paid staff and volunteers, all of whom hold a current Working With Children Check. However, please note that the Shire of Nannup, its employees, and volunteers are not responsible for the arrival or departure of your child, their behaviour while at Youth Zone, or any accidents that may occur.

We encourage parents and guardians to discuss expectations with their child and ensure they understand the importance of respectful and responsible behaviour while attending.
Name (Child Name)

First NameLast Name
Date of Birth

MonthDayYear
Date
Parents' Consent
Parents and guardians are encouraged to make an informed decision regarding their child’s participation in the Youth Zone by considering the nature of the space and any associated risks.

We welcome your questions and are happy to provide any information you may need. Please feel free to contact Apryl Longford, Community Development Officer, on (08) 9756 1018 during business hours.

Your involvement and understanding are important to us as we work together to provide a safe and positive space for young people in our community.
Parents Details
(1) Parent / Guardian

First NameLast Name
(2) Parent / Guardian

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (1)
Please enter a valid phone number.
Phone Number (2)
Please enter a valid phone number.
Email
example@example.com
Transport
The Youth Zone will be open after school hours, but we are aware that some children live out of Town. If you would like a bus service to deliver your child to a nominated drop off point, please discuss with the Youth Officer, we want every opportunity for your child to participate.
Medical and Transport Consent
Does your Child have any Allergies
If yes please state
Does your child suffer from any medical conditions?
If yes please state
In the event that I cannot be contacted, I authorise the Youth Zone Coordinator or designated staff member to:
- Consent to my child receiving any medical, surgical, or first aid treatment as deemed necessary by a qualified medical practitioner.
- Administer first aid as considered reasonably necessary by the person in charge.
- Arrange for my child to be transported in a privately owned vehicle by an authorised supervisory staff member or by ambulance if required.
Signature for Medical Consent

Clear
Photograph Consent
We love to promote our photos of the great things that are happening in Nannup, but we need your support to do so.

I give my permission to the Shire of Nannup to use photographs or video footage of me for the purpose of promoting the Youth Zone in a respectful and appropriate manner.

I understand that these images may be used in a variety of formats, including but not limited to print publications, online content, presentations, websites, and social media platforms.

I acknowledge that I will not receive any royalty, fee, or other form of compensation for the use of these images.
Signature for Photographic Consent

Clear
I have read all of the above information provided by the Nannup of Shire in relation to the Youth Zone.
I give permission for my daughter/son
To attend Youth Zone for the 2025 sessions.
(1) Signature of parent / guardian

Clear
(date)

MonthDayYear
Date
(2) Signature of parent / guardian

Clear
(date)

MonthDayYear
Date
Should be Empty:

YOUTH ZONE PARENTS CONSENT FORM

Parents' Consent

Parents Details

Transport

Medical and Transport Consent

Photograph Consent