Parent / gardian
Name *
Name
Address *
Address
Child One
Name *
Name
Gender *
Date Of Birth *
Date Of Birth
Any Allergies or Special Needs Our Team Should Be Aware Of?
CHILD TWO
Parient Gardian Aunty/Uncle Other
Name
Name
Gender *
Date Of Birth
Date Of Birth
Any Allergies or Special Needs Our Team Should Be Aware Of?
Medical Consent
*
I understand that whilst every precaution will be taken to ensure the wellbeing and protection of the attendee, Youth Alive and it's staff and leaders are hereby released from any and all liability in the event of and accident, damage or loss that may occur to the attendee and their property. In case of an emergency, I hereby give permission for the First Aid Officer to ensure proper treatment for the attendee. I have included all required health information that the First Aid Officer needs to know.
Involvement Consent
*
I hereby give permission for the attendee to participate in any activities they choose to over the course of the event
Photography & Video Consent
*
I hereby give permissions for the attendee to be captured in both photographs and video at NOW Conference 2014. Youth Alive reserves the right right to use this material for promotional purposes.
Other Authorised Pick Up & Sign Out
*Please note anyone who is not listed with the child's registration will not be authorised to sign your child in and or out of the program.
Name *
Name
Confirm
*