Childs Name DOB Guardian name Email Contact number Do you give permission for Likeminds staff to transport your child or children in their vehicle? YesNo Do you consent for Likeminds to take photos and video and use images and or video footage on social media? YesNo Does your child have any medical conditions, medication requirements or injuries that we need to be made aware of? Does your child 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 Likeminds program and while in the care of appointed coaches, there is risk of physical injury. As the parent/guardian I voluntarily accept the risk associated with the child's participation. I agree to release, defend, hold harmless and indemnify Little Leaders Australia/Infinite Possibilities/Likeminds 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 Please make sure you click the submit button: