Youth Services Registration Form

This registration form allows the participant to attend and participate in all Shire of Murray Youth Services, including High school Hang out programs and school holiday activities, for the calendar year in which it is completed. Updated forms will be required each year.

Participant Details

Parent / Guardian Details

Relationship to Young Person*This field is required.

Additional Emergency Contact Details

In the case of an emergency, we will always try and call the parent/guardian contact first, however, if they are uncontactable this emergency contact will be used. Please provide a different contact to the one listed above.

Relationship to Young Person*This field is required.

Medical Details

Food or other Allergies*This field is required.
Medication (if appropriate)*This field is required.
Dietary requirements*This field is required.
Medical condition*This field is required.

Photography / Videography Consent

Please note that filming/photography may take place at youth events for internal and external media purposes. The photographs and recordings made are likely to appear on our website or social media. If you would prefer not to be photographed, please let us know. There is no reward or remuneration for the publication of photos or videos.

Photo/video consent can be withdrawn at any time by advising staff verbally at an event (for that specific event) and/or in writing for all future events.

Do you give photography consent?*This field is required.

Participant Attendance Conditions Consent

I consent to participating in this program and act in alignment with the policies created for all participants. I agree that:

• I will always act in a courteous and respectful behaviour to all staff, volunteers and other participants, and that I will respect any buildings, vehicles or property I encounter.

• I will have fun and try my best at the activities offered. When I am not participating, I will observe or engage in another quiet activity that does not disrupt other participants.

• I am encouraged to provide feedback and suggestions on these and other activities and events that I would like to take part in.

• I understand that if I choose to bring personal belongings, they are my own responsibility to look after and the program facilitators and Shire of Murray hold no responsibility if these items are broken, damaged, or lost.

• I understand that disrespectful and inappropriate behaviours will not be tolerated and may result in being asked to leave the program, and that my parent/guardian will be notified of my behaviour. This includes being under the influence of alcohol or other drugs.

• I understand that repeated inappropriate behaviours may result in a ban from attending future programming and that the length of the ban will be proportional to the behaviour displayed and any prior occurrences.

I understand and agree to the conditions listed to attend the Youth programs and/or events organised by the Shire of Murray.*This field is required.

Parent / Guardian Attendance Conditions Consent

I consent to my child/ward participating in this program in alignment with the policies created for all participants.

In addition to the participant commitment above I agree that, although I realise every care will be taken:

• My child/ward has read (or been read), understood, and signed the participant agreement.

• I understand that youth programs like High School Hang Out are a Drop In style program, once the registration form is completed participants are able to attend sessions without the need for a parent/guardian to bring them or to be present at the event or venue.

• I understand that these Drop In style programs are open door and that while only registered participants are permitted to enter, these participants are free to come and go throughout the session and do not require a parent/guardian to collect them at the conclusion of the event.

• I understand that it is my responsibility to make appropriate travel arrangements for my child/ward to attend these sessions and any necessary arrangements for after the sessions.

• I understand that Shire Staff will facilitate the programs and monitor behaviours within the event or venue but that their duty of care does not extend to participants movements to or from the event or venue, nor outside the event or venue should they leave while the session is still underway.

• I give consent to staff to take whatever action deemed necessary to ensure the safety and wellbeing of all participants.

• I authorise staff to obtain medical assistance that they deem necessary and agree all medical expenses including ambulance transportation for participants is the responsibility of the parent/guardian.

• I understand that the Shire of Murray has a behaviour policy for these activities and if my child/ward breaches the behaviour policy they will be asked to leave immediately.

•I understand that the Shire of Murray has a behaviour policy for these activities and if my child/ward breaches the behaviour policy they will be asked to leave immediately. Should my child/ward be required to leave it is my responsibility to ensure that they are able to take their usual method of transport from the session, including to collect them if required, or to cover any associated costs for my child/ward to be transported to their home or other appropriate place.

• I release the Shire of Murray, its staff and contractors and indemnify all against any accidents to my child/ward, and loss and damage to personal property when taking part in Shire of Murray Youth programs and events.

I understand and agree to the conditions listed for my child/ward named above to attend Youth programs and/or events organised by the Shire of Murray.*This field is required.

Privacy Information

Details collected in these forms is for use in relation to Shire of Murray Youth Programs and will be stored appropriately and not shared with third party organisations.
Contact details will only be used by the Shire for sharing youth related information with parents/carers or direct contact relating to the named participant.