Minecraft LAN Party- Permission, Medical and Safety Form

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Monday 8th of July from 10 am until 1 pm.

Email *

Phone number

Emergency contact name

Emergency contact number

Kid’s name

Kid’s age

I give permission for my child to attend the Minecraft LAN Party on 8 July 2024

Yes

Clear selection

Does your child suffer from allergies?

Yes- food

Yes- medications (e.g penicillin)

Yes- insect bites

Yes- grasses and plants

Yes- mould

Yes- other

Clear selection

If you answered YES above please list the signs and symptoms of your child's reaction or type n/a

Does your child suffer from any medical conditions? (asthma, diabetes, epilepsy, etc).

Asthma

Diabetes

Epilepsy

Other:

Clear selection

Please note any details of the medical management program that the staff may need to be aware or type n/a

Medicare number and expiry

Private health fund and number or type n/a*

I understand that my child will need to demonstrate respectful, responsible and safe behaviour and follow all Society City rules to be eligible to participate in this activity

Yes

Clear selection

I agree that if my child does not follow the guidelines and rules at venues during the activity, I may be required to pick them up from the venue prior to the conclusion of the activity

Yes

Clear selection

Is there any other relevant information we need to know to ensure the wellbeing, health and safety of your child?

Yes

Clear selection

If yes, explain below

I give permission for the staff of Society City and/or a third party (doctor, hospital, paramedic) to use this information to facilitate the medical treatment and/or the health and safety of my child if necessary

Yes

Clear selection

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