Young Mayors Mackay - Library After Dark consent form

Library After Dark Consent Form

The Mackay Youth Council, a partnership between Mackay Regional Council and the Foundation for Young People (FYA), are excited to welcome you to a Library After Dark Free Movie Night.

When: Friday 5 July, 4pm – 8pm
Where: Gordon White Library, 54 Phillip Street Mackay, QLD 4740

How much will it cost?
Free. Including snacks.

What is FYA’s safety policy?
The young people’s safety and wellbeing is our number one priority. Participants will be under supervision of a responsible adult (a staff member employed by FYA) at all times. All responsible adults have Blue Cards. You can view the FYA Child Safety and Wellbeing Policy at fya.org.au/safety.

Who are the key contacts at FYA?

Savannah Vella, Young Mayors Program Assistant (Mackay), 04899 96 345
Cara Gjuzi, Acting Senior Coordinator Community Programs – Mackay Regional Council, 0436 673 519
Donna Kellion, Digital Literacy & Young Adult Librarian, 0436 631673

Consent Form

We ask for some personal details in this form. This will be used to manage your participation at the event.

We will also use this information to add you to our mailing list to receive communications about our upcoming programs, events and opportunities. If at any time you wish to opt-out of receiving communications from us, you may unsubscribe using the link provided or email us at privacy@fya.org.au

Participant Information

Full name(Required)

Do you have dietary requirements?

Do you have accessibility requirements?

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)

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)

Participant 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 'Library after Dark' event, and understand the nature of the activities and authorise my child’s participation in these activities.
I consent to The Foundation for Young Australians (FYA) collecting my child’s personal information for the purpose of their involvement in the Young Mayors program.
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 Mackay Regional Council will interact with my child in a way consistent with FYA’s child safety and wellbeing policy

Parent/guardian’s full name(Required)

Date(Required)

Parent/guardian's email(Required)

Emergency Contacts

Emergency Contact

Phone number

Emergency Contact

Phone number