Kyogle Youth Action Permission Slip

PARTICIPANT’S DETAILS

EMERGENCY CONTACT

TRANSPORT OPTIONS

MEDICAL INFORMATION

KYA staff are first aid trained and able to respond to first aid injuries associated with KYA activities.
KYA staff are not able to administer medication to young people. Young people must be able to self-administer their medication to participate in KYA activities. Please contact Youth Workers to discuss this further if needed.

DIETRY REQUIREMENTS

PERMISSIONS

By filling and signing this form you give permission for your young person to attend this event and engage in the activities held.

If applicable you are also giving your young person permission to travel to and from the event using a bus service organised by KYA. It is your responsibility to organise pick up / drop off at the agreed meeting point at the times given by KYA.

For further information

Kyogle Youth Workers:
0406 725 166
0460 578 866

Village Youth Worker:
Kyrstie – 0458 394 713

Kyogle Together Inc. acknowledges the Gullibul, Githabul, Wahlubal and Banjalang people who are the Traditional Custodians of the land and waters within the Kyogle Local Government Area, and we pay our respects to Elders past, present and emerging.