XG Youth WAKE-O-THON Parent/Guardian Permission Form
PLEASE FILL IN A SEPARATE FORM FOR EACH PARTICIPANT
On Friday 11th and Saturday 12th November, XG Youth will be participating in a Wake-O-Thon and your signed permission is required for your child to participate. The activity will take place under the guidance and supervision of XG Youth Leadership Team. A description of the event is as follows:
Name of Event:
Designated Responsible Person(s):
Contact Details of Responsible Person(s):
Start Date & Time:
End Date & Time:
XG Youth Wake-O-Thon
C3 Church Wynyard - 30 Austin St, Wynyard TAS 7325
Nathan & Jacinta Humphreys
N - 0476 988 161, J - 0473 901 012
Friday 11th November at 8pm
Saturday 12th November at 8am
I acknowledge that my child participates at his/her own risk in all activities held over the duration of this evnt. I understand that XG Youth (as a ministry of C3 Wynyard) will take reasonable steps to provide a safe environment for my child and to ensure that all equipment supplied by them for all activities is of a reasonable standard.
I acknowledge that XG Youth (or C3 Wynyard) will not be liable for any injury that may be suffered by my child.
I hereby agree to indemnify XG Youth (and C3 Wynyard) against any and all claims arising from, or in connection with, any injury that may be suffered by my child, or that my child may cause to another person, as well as any loss or damage to property, equipment or personal effects belonging to my child, or any other person.
I agree that XG Youth (or C3 Wynyard) may authorise, on my child's behalf whatever medical treatment he/she may require (this includes, but is not limited to, ambulance attendance and hospital treatment) and I agree to pay all medical expenses incurred.
In the event of my child greatly misbehaving, I give permission for their emergency contact to be notified. In addition, if it is no longer possible to have them at the event I agree that they will be collected by a family member or guardian, or be driven home by a responsible adult in the event of a family member or guardian being unavailable.
Indicates required field
Parent/Guardian Name 1
Parent/Guardian 1 Emergency Contact Number
Parent/Guardian Name 2
Parent/Guardian 2 Emergency Contact Number
I understand that by clicking the button below I agree to the terms and conditions listed above.
30 Austin Street
Phone: +61 3 6442 1221
Mobile: 0455 582 777
Find Us Online: