Childs Name


    Guardian name


    Contact number

    In the unlikely event of an accident I will accept the decision of appointed staff in relation to any urgent or immediate treatment required.

    I give permission for my child(ren) to attend CCVR at Erina Fair by means of transport organised by Likeminds staff.

    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.

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