Youth Event Consent Form

Youth Activity/Event Consent Form

Our youth groups are currently at capacity. Please indicate if you consent to being placed on a waiting list should a position become available.

Yes

No

Select Event you'd like to Register for.

Girls Group

Art Group

Outdoor Pathways

Parent/Guardian First name

Parent/Guardian Last name

Parent/Guardian Email

Parent/Guardian Phone

Emergency Contact Full Name

Emergency Contact Phone

Youth First Name

Youth Last Name

Date Of Birth

Day

Month

Year

Age

Youth Phone

Culture

Aboriginal

Torres Strait Islander

Both

Other

Language Spoken At Home

Country of Birth

Specific Dietary Requirements

N/A

Gluten Free

Dairy Free

Food Allergies

I agree to receiving Group text messages regarding this event.

Yes

No

Parent/Guardian Photograph and Media Authority. I (Parent/Guardian) Accept this Photograph and Media Authority.

Yes

No

Permission/consent and indemnity agreement. I (Parent/Guardian) accept this Permission/Consent and Indemnity Agreement.

Yes

No

Medication Agreement: I (Parent/Guardian) agree to...

I (parent/guardian hereby authorise (participant) to carry, hold and administer their own medication.

I (parent/guardian hereby authorise ELAM Staff to carry, hold and administer medication.

In case of an emergency: If in the event of an emergency I (parent/guardian) Give Permission for ELAM Inc. staff to (a) administer first aid and (b) give permission to call emergency services if necessary.

Yes I agree

No

I acknowledge that I have read and understood the information provided and consent for the participant to attend the selected ELAM activity.

Yes

No

Signature

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Youth Event/Activity/Group Consent Form

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