1.
Young Person's Details
Full Name
Date of Birth
Age
Gender
Phone
Email
Address
Postcode
2.
Parent/Guardian Details
Full name of parent/guardian
Relation to participant
Mobile
Alternate number
Email
Address (if different from young person)
3.
Please provide another contact in the case of an emergency
Full Name
Relation to participant
Mobile number
Alternate number
4.
 What program(s) will you be attending?
5.
Please provide any relevant health information you feel will assist us in providing appropriate care, support and a safe environment for you or your young person
Please provide
Young Person's Agreement

I will,

ACT in a way that shows respect for the centre, its users and myself

BELONG to a group that values me, my property and my personal safety

COMMIT to being responsible for my behaviour and the outcomes from it

6.
By entering your name below, you agree to the above ACT, BELONG, COMMIT principles
Name
Date
7.
To enable young people’s access to the City’s youth services, a transport service is offered for some activities and programs on a regular basis.This may include return trips from Youth Centres or an external location to an activity.
 
Whilst the City maintains duty of care for the young person at programs/activities, youth centres and whilst being transported, this does not extend to any external location where a young person is collected from or dropped off.
 
For more specific session times and locations please see promotional material and www.y-lounge.com.au.
 
I give consent for the young person to access City provided transport for the following programs:
 

Parent/Guardian/Over 18’s Agreement 

In the case of an accident or illness, I give consent to the City to provide any necessary medical treatment and agree to meet any expenses incurred. I also give permission for the young person or myself to be transported to outside medical facilities for treatment if necessary.

I acknowledge that the City is not liable for any loss, damage or injury to property or person as a consequence of my or the young person’s participation in the Program. I also acknowledge that I am liable for any damage to property or injury to another person caused by me or the young person.
 
Promotional Photos and Videos
I understand that photos/videos may be taken by City approved photographers whilst I or the young person is participating in the Program and that these could be used in newspaper articles and other publications for promotional purposes. If you do not wish for you or the young person to be present in any photos/videos please advise the City’s Senior Youth Worker in writing.

If at any time you would like to make changes to any of the above, please do so in writing by contacting the City’s Youth Services team via youth.services@joondalup.wa.gov.au.
8.
Do you agree to the Consent and Behaviour Policy listed above?