Knox Nocturnals
Knox Nocturnals SIGNUP FORM
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About
Participating in The Knox Nocturnals Youth program will be great fun. 
It is a free social inclusion program for 12-18 year old's living in Knox.
The program supports and connects young people of all abilities in a safe inclusive environment.
Young people participating in the program get the opportunity to meet and build friendships, gain new skills, build confidence, and have fun. to find out more click on the links below.

The program features:
  • A range of activities including sport, street dance, circus skills, arts and other fun activities
  • A healthy hot dinner and supper
  • Personal development
  • Life-skills workshops- topics may include relationships, mental health, self-care, drugs and alcohol, online safety and more
  • Transport home by mini bus can be provided if needed but is only available for those that live in Knox.
And it's all FREE !

Entering more than one participant
After you submit this application, you will have the option to enter an additional application for another participant. Note, all details will need to be added again, thank you for your patience.

Please complete all sections
Full Privacy Statement

The personal information requested in this application form is for the purpose of  administering the Knox Nocturnals Youth program and will only be used by the Rotary Club for that primary purpose or directly related purpose. 

Whilst information relating to the program may be published or shared for reporting and evaluation purposes, personal information in regards to individuals will not be disclosed except as required by law. 
Requests for access to and/or amendment of personal information should be made to the Knox Nocturnals Program Manager
Dates
Term 4 - 2024 & Term 1 2025
Knox Nocturnals Program - Location 
Carrington Park Leisure Centre
20 O'Connor RD, Knoxfield Vic 3180
Contact us via Email
info@knoxnocturnals.org
Phone Contact - 0460 311 268
Participant Details
Participant LAST NAME *
Participant FIRST NAME *
DATE OF BIRTH *
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Current AGE *
Participant Phone CONTACT Number *
Participant Address *
Participant EMAIL ADDRESS *
Participants GENDER *
Does the participant IDENTIFY AS *
Participant  DIETARY REQUIREMENTS *
Required
Please list any other DIETARY REQUIREMENT details.
Does the participant have any HEALTH ACTION PLANS? 
Please provide a detailed and current copy of the Action Plan/s
 *
Required
Any SPECIAL SUPPORT needs for the participant.
 *
Required
Please provide full details regards any special needs for the participant.
Please include details regarding how the participants special needs can best be supported in this program.  
Conditions for Participants
This program is generally restricted to participants from Knox suburbs.
Participants who don't live in Knox but who have connections to Knox MAY ALSO APPLY.
If the participant IS connected to Knox we want to understand what that connection is please.
Please tell us which suburb you live in. *
Required
Connection to Knox *
Required
Emergency Contact Details
Relationship *
Name *
Mobile Phone Number *
Home or Other Phone Number *
Secondary Emergency Contact Details 
Relationship *
Name *
Mobile Phone Number *
Home or Other Phone Number
Parent or Guardian Contact Details
Relationship *
Required
Full Name *
Email Address *
Mobile Phone Number *
Home or Other Phone Number
Privacy Statement, Photo, Image Permission and Parent or Guardian  Agreement
The Knox Nocturnals respects the privacy of anyone who interacts with us and is committed to protecting and managing personal information fairly and lawfully.

Please refer to our Privacy Policy available on our web page or on request to our program manager or nominated person.

Images (that don't name individuals) and de-identified data collected may be utilised for the purpose of program operation, safety, promotion, reporting as well as part of future grant applications or program evaluation by the Rotary Clubs of Knox.

Photo and Video Image Waiver 

Your consent is required below for permission to use photos, videos or the like which may contain images of your child, taken as part of the Knox Nocturnals Youth Program and associated activities. 

The images may be be used now or in the future for the purpose of external communications, including advertising and marketing as well as posted on the KNY program’s social media account(s) including Facebook, Instagram and website.

You may withdraw this consent at any time by advising the Knox Nocturnals Program  Manager or nominated contact via email (info@knoxnocturnals.org) or by  phone on 0460 311 268.

If you withdraw consent, the Rotary Clubs of Knox agree to not further use photographs or video footage it holds in the future, however, any photographs or video footage which are already published and in circulation cannot be retracted or removed from publication.

Privacy and Photo Agreement *
As the participants legal guardian, parent or carer;
I authorize the organizers to take what action may be required to ensure the safety of all participants and volunteers at Knox Nocturnals.
I authorize the organizers to obtain medical assistance in the event of any accident or illness as is required and agree to meet any expenses.
I acknowledge that participation in this program is at my child's own risk.titled title
Participants legal guardian, parent or carer authorisation;
 *
Please enter your FULL NAME & DATE OF BIRTH (Participant) *
Participant Agreement
I agree to - Participate and engage within the program
I agree to - Respect Confidentiality.
I agree to - Respect all participants including young people - staff and volunteers.
I agree to - the terms in the Privacy Statement.
Participant Agreement
 *
How did you learn about the program? *
Required
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