Please complete the below information to ensure you are registered for this program.
Participant's Name
Participant's School
St Anthony's
Riverside Primary School
Exeter Primary School
Beaconsfield Primary School
Trevallyn Primary School
Launceston Christian School
Exeter High School
Riverside High School
Home School
Other
Participant's Age (must be aged 10-17 to attend)
10
11
12
13
14
15
16
17
Parent/Guardians Name
Parent/Guardians phone number
Email Address
Participant 1 - Please list ALL Medical Conditions/Allergies/Dietary Requirements
Emergency Contact 1 - Name and phone number
Emergency Contact 2 - Name and phone number
Paint & Snack
Friday 27th June
4:00pm-6:00pm
Windsor Community Precicnt
Paint & Snack
Yes
Select which travel permission you wish to grant your child.
*Note* they cannot walk from or leave the premises unless you have given them permission to do so. (Please select ALL that apply)
I authorise WTC staff to contact emergency services 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(s).
The health information supplied above is accurate to the best of my knowledge.
I agree that if my child/ren misbehaves, becomes ill or for any other reason deemed appropriate by workers, I will collect them from the activity when requested by staff to do so.
I consent to my child/ren having their photo taken whilst participating in West Tamar Council (WTC) Youth activities for the purpose of being used for YAC promotions, media, and other council publications.
Photo Permission
Yes I consent
No I do NOT consent
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. West Tamar Council provides the program for all young residents. We like to include all young people in the activities, so if there are any issues, barriers or financial problems, please feel free to contact Council to discuss these matters on 63239200. To make any suggestions for future activities, please email youth@wtc.tas.gov.au