Hedland Sports+Rec Expo Registration

Participant's Details

Child's Given Name*

Child's Surname*

Age*

Allergies/Medical Conditions

Parent/Guardian

Parent/Guardian Name*

Contact Number*

Email*

Group Preferences

Would you like your child to be in a specific group?

YesNo

Waivers and Authorisations

Image Release*

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

Waiver*

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 this event, 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 this event.