Little Leader name DOB
What Year is my Little Leader in? KindyYear 1Year 2Year 3Year 4Year 5Year 6Other
Guardian name
What school does my Little Leader attend?
Email
Which day(s) are my Little Leader attending? Thursday onlyFriday onlyBoth
Contact number
Do you consent LLA to take photos and use images on social media? YesNo
Does your Little Leader have any medical conditions, medication requirements or injuries that we need to be made aware of?
Does your Little Leader have any dietary requirements?
In the unlikely event of an accident I will accept the decision of appointed staff in relation to any urgent or immediate treatment required. Agree
I have read and understood the contents of this form and warrant that all the information provided by me is true and correct. I can confirm that I understand that while every due care and diligence will be extended to the child during their participation in the Little Leaders Australia camps/programs and while in the care of appointed coaches, there is risk of physical injury. As the parent/guardian of the Little Leader I voluntarily accept the risk associated with the Little Leaders participation. I agree to release, defend, hold harmless and indemnify Little Leaders Australia and their employees and agents from and against any actions, claims, demands, expenses and liabilities however arising from injury, loss or damage arising from my son/daughter's participation in the program. Agree
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