Base Camp Rock Climbing September 2024 • Willoughby Park Anglican Church

First Name *

Last Name *

Allergies/Special Diet/Medical Conditions *

Tip: Please list any known issues and how you would like us to handle the situation if the issue occurs

Medicare Number

Media Permissions *

Yes

Tip: I give permission for photos/videos of my child/young person to be taken that may be used to advertise the group both in print and online.

Prohibited Persons *

Tip: Is there anyone who is legally restricted from seeing your child?

Comments

Tip: Any other information it would be helpful to know about your child

First Name *

Last Name *

Relationship to Child *

Contact Number *

Email Address *

I give permission for my child to attend the Base Camp event at Climbfit St Leonards on September 6th, 6pm-8pm
I authorise the Willoughby Park Anglican Church youth leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue or other services that are considered necessary for my child. All attempts to contact the parent should be made beforehand.
My child is aware of their physical ability. If not, I have given details above.
Transport of my child to and from the event is the responsibility of the parent/caregiver and will not be organised by the Base Camp leaders.
I acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my child being sent home and being temporarily or permanently prohibited from attending activities.
I will provide the leaders with any information relevant to the wellbeing of my child prior to him or her attending an activity.
I confirm that the information given in this form is true and correct, and will advise of any changes to this information.

I Agree *

Yes