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Online Form - Have A Try Night - Individual Child Registration - Friday 29 Mach 2019

Please register each child participant individually

Participants Details

Emergency Contact

Photographer Permission

I authorise the Town of Port Hedland to publish and reproduce any photographs of my child in both printed and electronic formats for the purpose of inclusion in Town of Port Hedland in-house publications, external publications and on the Town's website.


I hereby waive, release, and discharge the Town of Port Hedland and legal representatives, administrators, and executors for all liability for or by reason of any damage, loss or injury (including death) to myself, my child, or my property which has been or may be sustained as a result of my child’s participation in the 2019 Have a Try Night, and notwithstanding that such damage, loss or injury may have been caused solely or partly by the Town of Port Hedland’s negligence. I accept children of which I am the legal guardian are solely my responsibility and not of the Town of Port Hedland, Town of Port Hedland employees or volunteers, community groups facilitating demonstrations and stalls or any other person/s assisting in delivery of the 2019 Have a Try Night.