Info Form

Parents Info Form

Youth's Info

First Name *

Family Name *

Date of Birth *

Gender *

Female

Male

School *

Grade *

Address *

Medical Conditions, Allergies, or Dietary Requirements

Parent/Guardian Info

Name *

Relationship to Young Person *

Phone Number *

Email *

Do you give our team permission to:

Photograph your young person? *

YES

Pray for your young person? *

YES

Administer Paracetamol if required? *

YES

Other Comments

Signature *

Clear

Date *

Skate/Scoot Form (optional)

At Grace Youth, we are implementing a skate and scooter park to be available on some nights of our program. We take utmost care for your child and seek to ensure all activities are above board with safety and legal requirements considered. In saying that, please read and complete the following waiver form if you would like your son/daughter to be able to participate.

I acknowledge that skating and scooting can be hazardous and that participating in such activities can be inherently dangerous. Serious accidents can and do happen, which may result in serious bodily injury or even death. I understand not all risks can be predicted and that I have voluntarily read and understood this warning, and that my child participates at his/her own risk.

I understand that the Grace Church will take reasonable steps to provide a safe environment for my child and to ensure that all equipment supplied by them for the activity is of a reasonable standard.

I acknowledge that to the extent permitted by law, Grace Church will not be liable for any injury that may be suffered by my child, which arises either directly or indirectly from, or in connection with, skating and scooting incorporated in this form.

I hereby agree to indemnify Grace Church 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, arising either directly or indirectly out of or in connection with the activity described in the schedule incorporated in this form.

I agree that Grace Church 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). I agree to pay all medical expenses incurred.

We have considered all levels of risks and adjusted accordingly to ensure all youth participating in this activity have minimal risk. Helmets are mandatory when on a skateboard or scooter.

10-Week Pass (optional)

A 10-week pass for $30 can be purchased using cash on friday nights at youth.