Youth Day Permission Form • Anglican Diocese of Bathurst

Diocesan Youth Day - Permission Form

Parents/Carers,

Please fill in the following form to allow permission for your young people to attend and participate at the Diocesan Youth Day on Saturday 7 June, from 10am to 2pm at Lake Canobolas, Orange.

Friends and family are also welcome to attend on the day!

Parent/Guardian Details

Youth Details

First Youth

Youth 1 Full Name

Youth 1 Email

Youth 1 Mobile

Second Youth

Youth 2 Full Name

Youth 2 Email

Youth 2 Mobile

Third Youth

Youth 3 Full Name

Youth 3 Email

Youth 3 Mobile

Fourth Youth

Youth 4 Full Name

Youth 4 Email

Youth 4 Mobile

Permissions & Medical Information

I give permission for the young people listed above to enter the water at Lake Canobolas for water sports (canoeing, kayaking, paddle boarding, dragon boating, swimming).

Yes

Do you give the leaders permission to administer first aid or seek medical assistance if required?

Yes

Please provide any relevant medical information (e.g. allergies, asthma, etc)

Emergency Contact Details

Please provide the emergency contact details of someone other than the parent/carer filling out this form.

Emergency Contact Name

Emergency Contact Mobile