PARENTAL/GUARDIAN PERMISSION FOR FUSE PROGRAM ACTIVITIES

At Churches of Christ in NSW (Fresh Hope) we believe that young people are important. We count it a great privilege to be able to have your child involved in the FUSE program. FUSE is a program run to create the opportunity to gather youth ministries from all across Sydney to come together with different events happening throughout the year. At FUSE we sometimes offer activities within the program that, if chosen to participate in, may mean an increased risk of injury. These programs may include but are not limited to: Jumping Castle, Sumo Suits, Mechanical Bull, Horizontal Bungee, Soccer/Touch Football, Skating, etc.

It is our aim that every child feels safe, loved and cared for within our programs. We strive to give your child the best care we possibly can while they are involved in our programs. In order to do this we ask that you complete the following form so that we have the relevant information needed to ensure your child is cared for in a responsible and professional manner.

We respect you and your family’s right to privacy and as such this information is not shared but is necessary to keep on file so that we can provide the best care.

If you have any questions regarding this form, or regarding programs we offer please don’t hesitate to contact the Fresh Hope Ministry Centre office during business hours:

T 02 8719 2600 | E [email protected] | W www.freshhope.org.au

Parental Permission: FUSE Program Activities 2016

First Name:

Last Name:

Email Address:

Mobile:

CHILD'S DETAILS

Child Name:

D.O.B

Private Insurance Provider:

Private Insurance Policy Number:

EMERGENCY CONTACT #1

Name:

Relationship to Child:

Mobile:

EMERGENCY CONTACT #2

Name:

Relationship to child:

Mobile:

MEDICAL CONSIDERATIONS:

Please provide details of any medical conditions we should be aware of below (incl. food, asthma, medication etc)

FURTHER COMMENTS/INSTRUCTIONS

Please provide further instructions/comments below

DISCLAIMER & PERMISSION

I (parent/guardian) acknowledge that the FUSE activities being participated in on 27 May 2016 and 18 November 2016 may mean an increased risk of injury. The programs may include but are not limited to: Jumping Castle, Sumo Suits, Mechanical Bull, Horizontal Bungee, Soccer/Touch Football, skating, etc. I acknowledge that the site will offer due care and attention in the supervision of activities. I acknowledge and accept all risks associated with the activities, and release Churches of Christ in NSW, Fresh Hope, Youth Vision NSW, and its servant and agents from all claims, actions, suits and demands from loss or injury to participant. I also give permission for medical and ambulance services, in case of an emergency, and agree to pay such costs. I understand that this information will be held on file.

Parent/Guardian Name:

Date:

Please enter the number shown: