Event Reg by Abel Haslett | May 15, 2024 | Uncategorized | 0 comments Youth and Self-Advocates Registration, Release, Consent and Risk Management FormsFull Name*GenderMaleFemaleDate of BirthMobileEmail AddressName of Parent/Primary carerCarer MobileCarer Home PhoneCarer EmailEmergency contacts when you are at campContact NameRelation to youContact Home NumberContact Mobile NumberTo attend the Outdoor camp, you must be able to say YES to each highlighted question I am or my family is a member of the NZDSAYesNoI will be 18 or older by the date of the campYesNoI will complete all tasks before, during and after the campYesNoI will share the information and experience with othersYesNoI am willing to follow instructions so we all have a positive time and minimise risksYesNoI have experience with air travel and overnight stays at a hotel/campYesNoI am vaccinated and my COVID-19 vaccinations are current YesNoI am fit and will participate in walking and adventure activitiesYesNoI am willing to fully participate in the training YesNoI am independent and can take care of my personal needs/cares YesNoI regularly participate in a social/recreation/leadership group (if there is one in your area)YesNoI have a support person who can assist me with post-course work. Their name isthey are myAcknowledgement of responsibilitiesTo attend the Outdoor camp, you must be able to say YES to each highlighted question I have read and understood the attached Traffic Light Behaviour - Code of Expected Behaviour - and I know what behaviour is expected of me YesNoI know that I will need to follow the health and safety guidelines provided so that I can keep safe and to help others to be safeYesNoRelease and ConsentI agree that my story and/or photographs can be published in the NZDSA’s CHAT21 JournalYesNoI agree that my story and photographs can be used to promote the NZDSA’s workshops or projectsYesNoI give permission for my e-mail address to be circulated to the other participants who attend the campYesNoI give permission for my home number to be circulated to the other participants who attend the campYesNoI give permission for my mobile number to be circulated to the other participants who attend the campYesNoRisk Management and Emergency ContactNamePhone and MobileEmailDoctorPhoneMobilePhysical description, please include the following:HeightWeightHair ColourEye ColourPlease attach a recent photographIf applicable: Let us know of any accessibility requirements: (Mobility, hearing, vision etc.)If applicable: Let us know of any specific support needs:Special Dietary Requirements: Please note all in this sectionYesNoDietary Requirement Details*What happens if you eat the wrong food?*What do you want us to do if you eat the wrong food?*Do you have any allergies, e.g. bee stings, penicillinYesNoAllergies Details*What happens if you have an allergic reaction?*What do you want us to do if you have an allergic reaction?*Do you have any medical conditions?YesNoMedical Conditions Details*Are you currently on medication?*Please provide full up-to-date details of what medication, dosage, when and who should administer? *Please indicate what we should do in the event of a medical issue. Call the doctor*Please read the following and then sign In the event of an accident or illness, I authorise the obtaining of any medical assistance on my behalf as may be deemed necessary by the staff of NZDSA. I understand and agree that I need to follow the Health and Safety Guidelines provided and that everyone attending is responsible for taking the necessary measures to ensure their own and others’ safety. I accept that whilst the New Zealand Down Syndrome Association Incorporated (NZDSA) staff, volunteer support workers and other organisations will exercise due care and employ health and safety risk management techniques in both support and activities, it will not be liable for injury, damage or loss which a delegate may sustain to themselves or their property whilst attending the NZDSA Youth Development Camp. I accept responsibility for my own actions and safety. I understand that the NZDSA will not accept responsibility for loss or damage of personal property. I have completed these forms to the best of my knowledge. I have read and understood the statement with regard to risk management and the privacy portion of this form. I have completed the criteria for attendance list. I agree to participate in the assigned tasks. Privacy The information provided will only be used for risk management purposes and for our records. Your information will not be given to any other agency or person without your permission. Type Full Name to Digitally Sign*Submit Submit a CommentYou must be logged in to post a comment.