End of Year Concert!

Member's Name *

First Name

Last Name

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Are there any allergies or medical management plans that Active Eight staff need to be aware of? *

Yes

No

Are they any behaviour concerns or foreseebale triggers that staff on the day need to be aware of? *

Yes

No

Are they any support strategies that you would like Active Eight staff to implement? *

Yes

No

MEDIA CONSENT *

We do/do not give Active Eight permission to use professional images and videos from the Sports Day for promotional purposes. This may include media articles and editorials, Active Eight website, print material (flyers, posters, etc.), social media, and grant applications.

Do give

Do NOT give

FIRST AID *

We do/do not give Active Eight permission for application of basic first aid provisions. This includes adhesive strips (e.g., band-aid), bandage or dressing; hospital crepe or confirming bandage; sterile saline solution; ice packs; and latex gloves.

Do give

Do NOT give