REGISTRATION

Please complete the form below to register for Art & Soul - Local Youth Art Club due to commence in week 1 of Term 2, 2025.

Art & Soul Registration Form

Parent / Guardian Information

Parent / Guardian First Name

Parent / Guardian Last Name

Parent / Guardian Email

Parent / Guardian Contact Number

Relationship To Child

Participant Information

Participant FULL Name

Participant Age

Participant Gender

Preferred Day

Tuesday

Friday

Either

Additional Information - Please list any allergies, medical conditions, or special needs that we should be aware of:

Consent and Waiver

General Participation: I consent to my child participating in the Art & Soul Youth Creative Club, supervised by volunteers with valid child safety clearances. I understand the activities may involve hazardous materials and tools.

Medical Consent: In emergencies, I allow club coordinators and volunteers to administer first aid or secure medical care for my child if I am unavailable.

Release and Indemnity: I release and hold harmless the Art & Soul Youth Creative Club, its volunteers, coordinators, and the Shire of Wongan-Ballidu from any claims related to my child’s participation. This includes negligence by any involved party.

Photography and Video Consent: I permit Art & Soul and the Shire of Wongan-Ballidu to use my child's images in publications and media without compensation. I waive the right to approve the final use of these images.

Club Format: I understand that Art & Soul Youth Creative Club focuses on peer connection, creative freedom, emotional regulation and sensory processing, rather than the teaching or refinement of art techniques.

I have read and understood this form and waiver. I agree to this freely and fully.