GEELONG YOUTH INNOVATION SUMMIT 2019
STUDENT EMERGENCY CONTACT FORM

We’re looking forward to this weekend’s Geelong Youth Innovation Summit 2019, proudly brought to you by girledworld in partnership with the Victorian State Government, City of Greater Geelong and Runway HQ.

In order to ensure this is a safe event for all of our student attendees, it is important we are aware of any pre-existing food allergies or medical conditions and have up to date emergency contact details for all students attending who are unaccompanied by an adult/guardian on either day of the Summit (Saturday May 11 - Geelong Cats GMHBA Stadium and/or Sunday May 11 - Runway HQ Geelong or both days).

Please note this form must be completed by parents/guardians prior to admission to the event for unaccompanied students.

Please complete the form below FOR STUDENT ATTENDING THE EVENT

Your name

First Name

Last Name

Name of student attending event

First Name

Last Name

School

Year Level

Relationship to the child

Contact phone on event day

(###)

###

####

Contact email on event day

How did you hear about the Geelong Youth Innovation Summit?

Where do you/the attending student currently go for careers/post-school course/job pathways information?

Food allergies

Does the attending student have any serious food allergies?

Yes ( If yes please complete the next question)

If you answered YES to the above question please complete the below.

Please note that no food will be served by girledworld Pty Ltd at the event venue/s. All attendees are required to provide their own food, or purchase food from event vendors. If your child carries an allergy device or associated equipment please indicate details below. Please note girledworld Pty Ltd and event crew are not liable for administration of said device / or associated equipment in the event of an emergency or where assistance is required.

Medical conditions

Does the attending student have any medical conditions that we should be aware of and that in an unlikely event of emergency may require medical attention during the event proceedings?

Yes

Informed Consent

PARENT/GUARDIAN CONSENT: I understand that as a parent/guardian I am providing consent for this student's participation in the Geelong Youth Innovation Summit 2019 at the Geelong Cats GMHBA Stadium (Saturday May 11, 2019) and/or Runway HQ Geelong (Sunday May 12, 2019). I confirm that I have read and have understood the attached information, which outlines the Geelong Youth Innovation Summit 2019 event details. Please note that further information on the event can be found at www.girledworld.com and in prior event communication post registration. STUDENT BEHAVIOUR: I understand that in the event that the behaviour of the student (for whom I am responsible) poses a danger to themselves or others during the event, the student may be removed from the venue and parents/guardians contacted to collect the student from aforementioned venue. I further understand that in such circumstances I will be informed, and where I cannot be contacted, that any costs associated with the student's removal from venue and return to safety will be my responsibility as parent/guardian of said student. LEAVING THE EVENT PREMISES: The Geelong Youth Innovation Summit 2019 being held at the Geelong Cats GMHBA Stadium (Saturday May 11, 2019) and Runway HQ Geelong (Sunday May 12, 2019) is a supervised event. It is expected that student attendees will not leave the event premises for the duration of the event. If student attendees do voluntarily leave the event premises throughout the duration of the event, a duty of care will no longer be owed by girledworld Pty Ltd if the unaccompanied or accompanied student decides to leave the event premises of their own accord. CONSENT FOR EMERGENCY TRANSPORTATION: In the event of an emergency I consent that the student for whom I am responsible has permission to be attended to in the initial instance by a member of the Geelong Youth Innovation Summit event and associated staff, and subsequently will be attended to by first arrival of emergency services who will be called immediately as first point of legal first aid administration. EVENT PHOTOGRAPHY / VIDEOGRAPHY PERMISSION: The Geelong Youth Innovation Summit 2019 will be captured by Girledworld Pty Ltd professional videographers and photographers. I hereby consent to the possibility of the student for whom I am responsible being photographed/videoed and/or visual images of said student being used in Girledworld Pty Ltd publications, online materials or for publicity purposes (with non-specific first name, age and city citing as acceptable as per industry standard), and that said student will expect no creative accreditation, professional acknowledgment or entitlement to any remuneration or compensation for appearance in said asset which will remain the proprietary property of Girledworld Pty Ltd. ANAPHYLAXIS POLICY: I understand that the event organisers of the Geelong Youth Innovation Summit have sought to minimise the risk of attending students coming into contact with nuts and nut products or nut product consumable derivatives. I agree to support this policy by not sending these products to the event. PARENT CONSENT: By clicking “submit”, I confirm that I have read the information provided by Girledworld Pty Ltd and give permission for the student for whom I am responsible across the event duration to participate in the Geelong Youth Innovation Summit 2019 at the Geelong Cats GMHBA Stadium (Saturday May 11, 2019) and/or Runway HQ Geelong (Sunday May 12, 2019) event venues.