Club Sign Up Form - Young Life Australia

Young Life Club or Area *

Attendee's First and Last Name: *

First

Last

DOB *

Child's Gender: *

Child's Email:

Child's Mobile:

School:

Parent/Carer/Guardian with whom the attendee primarily resides: *

First

Last

Residential Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email: *

Mobile: *

Home:

Work:

Secondary Parent/Carer/Guardian/Emergency contact *

First

Last

Email:

Mobile *

Home:

Work:

Medical Information

Medicare no: *

Expiry Date: *

Child position on card: *

Allergies: *

Medical conditions you would like us to be aware of: *

Other issues or concerns:

Please Note!

It is your responsibility to provide your child with medication they require. Young Life Australia does not provide medication at their weekly events. By signing this form, you acknowledge that if you child requires any medication, including for emergency situations, that you will send your child with what is required weekly and provide the Young Life staff person in charge of the event with the instructions for use.

Permission and Consent: *

I give permission for my child to attend a Young Life Club.
I give permission for my child to be transported home by the Young Life team if needed.

Consent to medical attention: I, the undersigned confirm my consent to the activities my child will engage in while on a Young Life activity or camp. I acknowledge the staff and volunteer agents of Young Life Australia will take all possible care but cannot be held responsible for unforeseen accident or illness arising. I hereby consent to medical, hospital, rescue procedures being employed in the best interests of my child and that I shall be notified as soon as possible should the continuance of such procedures be necessary. *

I agree

Disclaimer: In the unforeseen event of personal injury or illness sustained while on a Young Life activity or camp, or the loss of personal property except where such property was held in the custody of Young Life staff or volunteer agents when lost while on a Young Life activity or camp, I hereby release, and exempt, and indemnify the organisers, sponsors, and all other persons involved in the organisation of the Young Life camp, trip, excursion, from all action, proceedings, demands, costs, expense, and claims whatsoever made or taken by any person arising out of my child’s participation in such camp, trip, or excursion.

I agree

Discipline: If in the event your child's behaviour is deemed by the organisers to be inappropriate or compromises the safety and/or health of other attendees at the Young Life activity, on the camp, trip or excursion, then Young Life reserves the right to send your child home, at your expense, at the earliest possible time, by the most effective mode of transport, in conjunction with your co-operation.

I agree

Media Consent: Young Life Australia may take photos/video of your child to to use for promotional purposes.

I agree

Privacy: The personal contact/address details you supply on this form will be entered into our database. We may use it to send you further information about Young Life Australia. Young Life Australia adheres to the Privacy Act and will not disclose this information to third parties. If you would like to know what information Young Life holds about you please call 1300 557 647.

I agree to receiving information from Young Life Australia

Signature *

Date: *

If you have any questions or concerns about Young Life in your local area, please contact the National Young Life Office.

P: 1300 557 647 E: office@younglife.org.au W: younglife.org.au F: facebook.com/younglifeaustralia

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Medical Information

Please Note!

If you have any questions or concerns about Young Life in your local area, please contact the National Young Life Office.

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