Nature Play Registration Form

Required fields are marked with an asterisk (*).

Parent / Caregivers Details * First and last

Phone Number *

Email address *

Children's Details

Name * Child 1

Date of Birth *

Relationship to Adult *

Name Child 2

Date of Birth

Relationship to Adult

Name Child 3

Date of Birth

Relationship to Adult

Name Child 4

Date of Birth

Relationship to Adult

Emergency Contact Details

Name *

Phone *

Email *

Consent, waiver & Indemnity

I agree to the following conditions * 1. I understand the inherent risk in the activity. 2. I acknowledge that I participate in the event at my own risk. 3. I understand to comply with all instructions given and will comply with all reasonable directions and decisions of the officials and other representatives of Roxby Link, Roxby Council, Healthy Environs, BHP and Arid Recovery. Failure to comply could result in the individual forfeiting participation in the event. 4. I release Roxby Link, Roxby Council, Healthy Environs, BHP and Arid Recovery from any claim and from any liability (to the extent permitted by law) for, or as a result of any loss, injury or damage suffered by me in relation to my attendance and participation in the event, how so ever caused, including any claim or liability which arises due to any negligence of the listed organisations. 5. I understand that there is an expectation of good behaviour and safe conduct during the event.

Promotional Consent

Do you give permission for yours and your childrens name, words, photographic image and video recordings for promotional and media purposes without restriction or payment or compensation by Roxby Link, Roxby Council, Healthy Environs, BHP and Arid Recovery. *

Agreement

I have read and understood this document and agree to abide by directions given by Roxby Link, Roxby Council, Healthy Environs, BHP & Arid Recovery to keep myself, staff and the community safe. I believe to the best of my knowledge that the information I have provided in this tool to be accurate and correct and understand I am agreeing on behalf of all names on this form. *

Community

Nature Play Registration Form

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