Registration Form

Participant Name *

Are filling out this form for a child or young person? *

Yes, I am a parent or guardian

Mobile Phone

Participant Birthdate

Gender ID

Address

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Any allergies? *

Yes

Medical conditions *

Primary emergency contact name *

Primary emergency contact relationship to participant *

Primary emergency contact number *

Primary emergency contact email

Permissions and Agreement

Participant Behaviour *

I have spoken to the participant/s named on this form to make sure they understand the behavioural expectations

Consent Questions

I consent to take part in the overall activities of this program. [OR] I give permission as parent or guardian for the participant named here to take part in the overall activities of this program *

I agree

I understand that, in the event of an emergency, The Salvation Army personnel will make every effort to contact those nominated. If they are uncontactable, I authorise The Salvation Army personnel to seek medical assistance, ambulance transportation and treatment for the participant as they think is necessary and agree to cover any associated costs. *

I agree

I acknowledge that photographs and/or videos may be taken of activity/program participants. I consent to these images being taken and published publicly for the purpose of promoting the program and/or printed to give to the particpant/s as keepsakes. *

I consent

I acknowledge that photographs and/or videos may be taken of activity/program participants. I realise that no names or other identifying information will be used and that I can withdraw my consent at any time by contacting the program leader *

I agree

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Registration Form

Permissions and Agreement

Consent Questions