OUR LADY OF THE ROSARY CATHEDRAL YOUTH GROUPS ACTIVITY PERMISSION
FAMILY NAME: ________________________________ FIRST NAME: _________________________
DOB: _____________ AGE: _________Yr.____ SIBLINGS: (Attending/Not Attending): ______________________
HOME PHONE: ________________________ CHILD MOBILE: _______________________________
EMAIL: ______________________
CHILD’s Domiciliary Parent(any special provision for privacy and contact to be noted here):
__________________________________________________________________________________
EMERGENCY CONTACT DETAILS: _______________________________________________________
ACTIVITY DATE: 19TH October Friday
VENUE: Praise and Worship Night at Holy Spirit Catholic hurch Kincumber: Event starts at 6:30pm- 9:00pm
TRAVEL ARRANGEMENTS: Meet at Church: at 4:45pm for the bus which will leave at 5:00pm sharp. Bring $2
coin for petrol and some extra money for a light supper. Bus will return to the church around 10:00pm.
** Note the bus will hold only 22 people if you are late you may miss out.
TRANSPORTATION: Many activities will start from Our Lady of the Rosary Cathedral will either travel by group
bus, public transport, or walk to all events and returned to Our Lady of the Rosary Cathedral for collection or
parents will provide transport to the venue by car or car pooling.
_________________________________________________________________________
I/We give/(do not give)* - (delete as applicable) permission for my child to participate in the Our Lady of the Rosary Youth Groups. I/We
give permission for the above mentioned information to be collected for the purpose of the running of the Groups and understand that it is
to be kept securely in accordance with the Privacy Act of 1988. I/We understand that from time to time it may be necessary to
communicate activities of the groups via email, SMS and/or Facebook, and I/we give consent for our and/or child’s email (delete as
desired) and that said electronic communication will be done under the strictest of privacy protocols, using the “BCC” format so that
my/&/or child’s email will not be in the public domain. I give / do not give permission for photos to be taken of my son/ daughter on
outings. These photos will be use for parish promotion only. Further details on the Privacy and Consent Protocol are printed on the flip
side of this form, and I/we sign that we have read and agree to them.
.............................................
.............................................
Child Signature:
Parent/ Carer
My son/daughter has the following special needs (please provide full details and include any relevant medical
details), including special dietary requirements and food allergies:
___________________________________________________________________________________________
___________________________________________________________________________________________
I give / do not give permission for my child to receive medical treatment in case of emergency.
........................................ .......
Parent/ Carer
Date
HCYG_Permission_Activity_Form_2012
The information being collected on this form is being obtained for the purpose of
ascertaining relevant medical information, requirements and other health care related
needs about your child, who is currently enrolled in the Hornsby Cathedral Parish Youth
Groups, and who may participate in youth group excursions, sporting activities or other
leisure activities conducted by or in conjunction with Hornsby Cathedral Parish Youth
Groups and the Hornsby Cathedral.
It will be used by the Youth Coordinator, staff of the Hornsby Cathedral Parish Youth Groups
to assist planning, to support youth group members, and to minimise risks when conducting
youth group excursions, sporting or other youth group activities.
Other persons or agencies that may be provided with this information include, but are not
limited to, volunteers and members of external organisations who join with the youth
groups and Parish, or are otherwise involved in the planning or delivery of the excursion,
sporting, leisure, or other youth group activity; and persons that may be called upon to
provide emergency health care treatment or other assistance during or as a consequence of
such excursions or activities.
Provision of this information is not required by law. However, a failure to provide the
information may mean that your child cannot participate in a particular excursion or youth
group activity. In such circumstances the Youth Group Coordinator or other designated
member of the Parish will inform you.
Provision of this information will significantly assist the Youth Groups Coordinator in
planning a safer educational activity. It will be stored securely. If you have any concerns
about provision of this information, please contact the Parish Secretary.
You may correct any personal information provided at any time by contacting the Parish
office secretary.
HCYG_Permission_Activity_Form_2012