Pathways to employment

17 June 2026

Pathways to employment form

2026 Participant Details - please note you have to be aged 14-17

PERSONAL DETAILS

Participants name

Participants date of birth

Residential address

Contact number

Email address

School & grade level

Medical Information - Medical Conditions, Allergies, Dietary Requirements (please specify)

Please detail medications and name of family doctor

IN CASE OF EMERGENCY

(please provide 2 names and 2 phone numbers that we can contact)

Text

1st Emergency Contact (name & phone)

2nd Emergency Contact (name & phone)

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 youth development officer, Kirsten Howard on 0437 789 103 or 6323 9206.

Participants agreement

I agree

Participants name

Date

Parent/Guardian agreement

I agree

Parent/Guardian name

Parent/Guardian phone number

Date

PHOTOGRAPHIC CONSENT

I consent for my childs photograph to be taken and used for the purpose of West Tamar Council marketing and advertising of youth programs. These images will only used on Council registered websites and social media pages such as YAC West Tamar on Facebook, yacwesttamar on Instagram and westtamaryouth.com.au, as well as all West Tamar Council pages and sites. I understand if i select NO that my child will not be photographed at any Council programs or events.