Young Mayors Cairns - Parent/Guardian Consent form

Participant Information

Full name(Required)

Do you have dietary requirements?

Do you have accessibility requirements?

Do you have any medical conditions or allergies you'd like to disclose?

Do you take any regular medications we should be aware of?

Consent and Agreement

This section is to be filled out by participants.

Conduct

FYA requires safe and respectful spaces for all. This precludes acts or threats of violence, or conduct reasonably likely to endanger the physical or mental health of yourself or other person, including but not limited to harassment, discrimination and the consumption of drugs or alcohol.

I agree to be respectful of all participants and to respect the health and safety of others.(Required)

Information Collection

My story, image and voice is my own and I give permission to the Foundation for Young Australians (FYA) to collect information about me by:

Interviewing me in person
Surveying me in writing
Taking photos of me

I agree to FYA’s collection of my personal info and have consent to fill out this form(Required)

Information Use and Sharing

I decide how other people use and share my story, image and voice

I agree that the information collected from me may be used by FYA:

For activities related to Young Mayors

For other activities related to FYA

I agree that the information collected from me may be shared:

With FYA partners

Publicly on FYA’s website, social media, newsletters and marketing materials

Privacy

Information about how FYA collects, uses, stores and discloses personal information, and how you can correct or make a complaint about how we have handled your personal information, can be found in our privacy policy.

I understand that my info will be managed in a way consistent with FYA’s privacy policy(Required)

Child Safety and Wellbeing

Information about how FYA protects children from harm, exploitation and abuse and prioritises the right of every child to feel physically and emotionally safe, including in the way information is managed, can be found in our child safety and wellbeing policy.

I agree that I will act in accordance with FYA’s child safety and wellbeing policy(Required)

Medicine

In the event of any accident or illness sustained I authorise staff from FYA to obtain emergency medical attention and/or an ambulance.

If required, give permission for FYA staff to administer:

Paracetamol

Ibuprofen

Either

Full Name(Required)

Date(Required)

Parent/guardian Consent Agreement

This section is to be filled out by parents/guardians.

Please fill out this section to signify your consent to the following:

I am aware of the Biri Bana Tour and Young Mayors and understand the nature of the program activities and authorise my child’s participation in these activities
I authorise my child to travel by bus supervised by an FYA employee both to and from Yule Point
In the event of any accident or illness sustained I authorise staff from FYA to obtain emergency medical attention and/or an ambulance
I agree and understand that financial responsibility for medical costs incurred in an emergency rests with the parent/guardian of the participant
I understand that FYA staff and volunteers will interact with my child in a way consistent with FYA’s child safety and wellbeing policy
I agree that my child gave informed consent to the collection and management of their personal information by FYA

If required, give permission for FYA staff to administer to my child: