Legana Youth Centre Membership Form

Legana Youth Centre 2024
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2024 Participant Details



(Please provide 2 names and 2 phone numbers that we can contact in case of an emergency)

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, Youth Development Officer of the West Tamar Council on 63239200. If this form is not signed by a parent or guardian, access to the Youth Club and its activities will be refused.


I agree to abide by the rules and values of The Legana 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 Beaconsfieldand surrounding areas and will only become an ongoing venture if I follow the rules and regulation


I hereby give consent for my child to participate in activities at the Youth Centre. I understand that transport to and from the centre is not the responsibility of the leaders or the program and will [Please indicate appropriate choice]

I understand that the centre is a youth club and the young people are only supervised whilst in the building, unless on group activities. I give permission for my child to have their photo taken whilst on the activities, to be used only by the West Tamar Council for reporting requirements/promotional material.

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 on behalf of the above participant. The health information supplied above is accurate to the best of my knowledge.