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

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

Participant Information

Consent and Agreement

This section is to be filled out by participants.


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.



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.


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.

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:

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

Emergency Contacts