Young Persons Name *

Name of the young person requesting bus transport

First Name

Last Name

Young Persons Contact Number *

We would like the young person's contact number in the event of an emergency while on site at the event

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Parent / Guardian Name *

Name of the young person's parent / responsible adult

First Name

Last Name

Parent / Guardian Contact Number *

Please provide a phone number of a responsible adult who is available to be contacted during the event

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Please read, understand and agree to the following: *

INVOLVEMENT CONSENT: I being the parent/guardian of the said young person hereby give my consent to be transported by bus under the supervision of INYouth Leaders. I give notice that the young person has purchased their own ticket to the event and I have given consent for them to attend the event as per Youth Alive's event consent policy. MEDICAL TREATMENT CONSENT: I being parent/guardian of the said child understand that whilst every precaution will be taken to ensure the good welfare and protection of my child, Imagine Nations Church, its staff and volunteers acting on behalf are hereby released from any and all liability in the event of any accident or misfortune, damage or loss that may occur to the child and their property. In the case of an emergency, I hereby give permission to the First Aid Staff to ensure proper treatment for my child. I understand that every effort will be made to contact me before instituting such procedures. I agree to pay all such doctor, ambulance and hospital fees incurred on behalf of my child. I will provide a list of any health information about my child that the First Aid Staff need to know. SUPERVISION POLICY: Imagine Nations Youth will provide supervision for the event in collaboration with Youth Alive (the event organisers). Young people will not be able to leave the site of the event and must travel to and from the event in transport organised by INYouth (unless another arrangement has been organised prior to the event in writing with approval from the Youth Pastor). PRIVACY POLICY: Imagine Nations Church is committed to protect the privacy of an individual’s information. Please refer to the Privacy policy on our website.

UNDER 18s: I consent as the parent (listed above) of the young person to the above conditions

OVER 18s: I consent as the person listed above to the above conditions

UNDER 18S ONLY: Name of parent giving consent? OVER 18S: Your name

First Name

Last Name