YWCA Canberra Clubhouse
Disc Golf at Edison Park
Dear Parent/Guardian,
The YWCA Canberra Clubhouse is offering an excursion to Disc Golf at Edison Park on Monday 9th January 2017. Young people aged between 10 and 18 that live in the Tuggeranong region who have returned this signed permission note are invited to meet at the YWCA Canberra Clubhouse at 12.00pm. The day’s activities will include Disc Golf and sports at Edison Park. The group will return to the YWCA Canberra Clubhouse at 4:00pm and the Clubhouse will shut at 5:00pm.
Excursion details:
Date: Monday 9th January 2017
Time and meeting place: 12.00pm at YWCA Canberra Clubhouse
Transport: Snow Foundation Community Bus
Cost: FREE
Food provided: None
Activities included: Disc golf and sports
What to wear: Please bring comfortable clothes and appropriate comfortable footwear
What not to bring:
- Any valuables or anything you don’t want to lose (the YWCA of Canberra holds no responsibility for the loss of any possessions)
- No alcohol, drugs or dangerous belongings.
Emergency Contact Details:
Youth Engagement workers’ names & mobile numbers:
Lachlan Howarth 0406 375 993 Activity Co-ordinator
Ciara Duggan 0450 962 868 Bus Driver and First Aid Officer
Please keep this copy for your reference
PERMISSION FORM, page one – please complete the following and return
Disc Golf at Edison Park on Monday 9th January 2017
I have read the above information and I give permission for my son/daughter/dependant,
(child’s full name) ______, to attend Disc Golf at Edison Park on Monday 9th January 2017. Please complete the following details and return to the YWCA Canberra Clubhouse before Friday 7th January 2017.
Parent/Guardian’s Signature: ______
Date: ______
Young person’s details:
Young person’s full name: ______
Mobile number (if they have one): ______
Date of birth: ______
Medical conditions or allergies: (please circle): YES NO
If YES please specify: ______
______
Does your child identify as Indigenous or Torres Strait Islander? (please circle)
Yes No
Is a language other than English spoken at home? (please circle)
Yes No
Emergency contact details:
Parent/Guardian’s full name: ______
Mobile number: ______
Home number: ______
Permission to Participate in: Youth Engagement School Holiday Program
Please read the School holiday program time table for the drop off times
In recognition of physical activities entailing some elements of personal risk, I acknowledge that The YWCA and its employees have undertaken strict practices to oversee safety, and are covered by Public Liability insurance. I willingly participate in the above-mentioned activity and agree that in case of emergency, medical and transport arrangements will be made on my behalf and I will be responsible for any associated costs. I agree that at all times I will act in a responsible manner, and should I fail to meet expected standards of behaviour, I may be required to cease the activity and/or be required to leave the activity (at my own expense if transport is required). I acknowledge that should I choose to leave the program for any reason, then YWCA staff will not be held responsible, but will inform one of the persons listed above (if the young person is under 18 years of age). At all times I acknowledge my responsibility in practicing sun-smart practices.
Participants Signature ______Date ______
I give YWCA of Canberra staff permission to administer first aid to my child in the event of an emergency. This may include calling an ambulance, transporting to hospital, etc. I am aware that if my child is injured whilst out that I will incur the cost of them being transported to the hospital and anything else that may occur.
Parent/Guardian Signature ______Date ______
(If participant under 18 years of age)
Photograph Permission:
As part of the YWCA’s commitment to promoting the efforts of young people participating in their community we often use photographs of young people in our publications. By signing this form you are indicating that you are happy for photographs of your child to be used in our publications.
I give permission for any photos taken of my child to be used in the promotion of the YWCA youth services: (please circle) YES / NO