IN CASE OF EMERGENCY
(please provide 2 names and 2 phone numbers that we can contact)
Please Note: All the information provided is treated in the strictest confidence, including any health information given. This information is sought in order to protect & assist the participant so that the activity may be a safe & enjoyable experience. If you have any questions please contact the coordinator of the Youth Centre, Kirsten Howard on 0437 789 103 or 6323 9206. If this form is not signed by a parent or guardian, access to the Youth Club and its activities will be refused.
PARTICIPANT’S BEHAVIOURAL CONTRACT
I agree to abide by the rules and values of The Beaconsfield Youth Centre, which have been set down. I also agree to respect the other users of the centre, the staff, volunteers and the neighbours in the area. If I break these rules, I can expect the appropriate warning or suspension from the Centre. I understand that the centre has been opened for the youth of Beaconsfield & surrounding areas, and will only become an ongoing venture if I follow the rules and regulations.
PARENT/GUARDIAN CONSENT
I hereby give consent for my child to participate in activities at the youth club. I understand that transport to and from the centre is not the responsibility of the leaders or the program and will [Please select ALL options below that apply]
I understand that the centre is a youth club and the young people are only supervised whilst in the building, unless on group outdoor activities.
I authorise the leaders to contact the participant’s nominated doctor in the event of an emergency, obtain other medical assistance deemed necessary in the event of an emergency/accident, including the administration of an anaesthetic or the carrying out of necessary surgical procedures by a qualified medical practitioner. I agree to pay all medical and dental expenses incurred onbehalf of the above participant. The health information supplied above is accurate to the best of my knowledge.
I agree to save Kirsten's phone number in my phone (0437 789 103).