Youth Collective Membership Form

Shire of Harvey
PART A - Personal Details
Please tick preferred method of contact for YC:

PART B - Emergency Contacts
PART C - Additional Information
Do you have any medical/physical conditions or any disabilities (Eg. dietary requirements, allergies, asthma, physical or other disability, or have a carer)?:

PART D - Parent/Guardian
Please read this form carefully and do not hesitate to ask questions if you are unsure:
  • Please check your details on the form are correct in case of emergency
  • Consent is required for young people to use social media to communicate with the Youth Collective and Shire of Harvey Officers.
  • Young people are required to uphold the Youth Collective Honour Code that is developed in partnership with members on the first meeting, this outlines expected behaviour. Any behaviour that is abusive, offensive or puts other young people or Shire Officers at risk will not be tolerated and young people may be asked to leave the program.
  • Information disclosed by young people to Shire Officers will be kept confidential unless there is risk to the young person or others.
Support Needs:
Shire Officers cannot provide care beyond basic supervision and support. A support worker must be provided if a young person has specific needs. Shire Officers do not administer medications or assist with medical issues.
Duty Care:
Shire Officers are committed to ensuring that the programs we offer are safe for all young people while they are on site. Shire Officers have current working with children checks and first aid qualifications.
Accident /Injury:
In the event of a serious injury, an ambulance will be called. Parent/guardian will be notified immediately and will be required to meet any expenses incurred.
Parent/Guardian Consent

I acknowledge the Shire of Harvey is not liable for any loss, damage or injury to property or person as a consequence of my, or my child’s, participation in the program. I also acknowledge that I am liable for any damage to property or injury to another person caused by me or my child.

I have read the conditions and give consent for my child to participate in the selected activities.

The Shire of Harvey uses photos and videos of local people for the purpose of marketing, educational and reporting purposes.

I give permission for photos/videos to be taken of my child for use as stated:

I give consent for my child to communicate with Shire Officers and Youth Collective members via phone or email: