Extra-Curricular Activity Consent Form Extracurricular Activity Consent Form Extra-Curricular Activity Consent FormPlease complete this form to provide consent for your child to participate in extra-curricular activities conducted on school premises during Outside School Hours Care (OSHC).Centre DetailsCentre*Select the centre where your child or children are enrolledChrist Our Holy RedeemerClayton South Primary SchoolDoveton CollegeRoxburgh Homestead Primary SchoolSouthern Cross Primary SchoolSt Andrew's Primary SchoolSt Anthony's Primary School (Glen Huntly)St Gerard's Primary SchoolSt Joseph's Primary SchoolSt Kevin's Catholic Primary SchoolSt Margaret's Primary SchoolSt Mark's Catholic Parish Primary SchoolSt Mary's Primary SchoolChild or Children's DetailsChild's Full Name Add RemoveChild's Date of Birth Add RemoveParent / Guardian's DetailsParent / Guardian's First NameParent / Guardian's Second NameParent / Guardian's Last NameAddress Address Suburb / City State / Province Postcode / ZIP AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone (Landline)Telephone (Mobile)EmailFamily Account Number / Australian Company Number (ACN)The 9-digit family account number shown in the top-right corner of your statement (e.g. 000-123-456)Activity During OSHC hours, your child may have the opportunity to participate in activities facilitated by an external provider. These activities are held on school premises but are not supervised by OSHC staff. Third-Party Provider The activity is conducted solely by an independent external provider not affiliated with Youth Leadership Victoria (YLV). YLV staff will not be present during the activity and are not involved in its planning, execution, or supervision. Liability Disclaimer By signing this form, you acknowledge that YLV is not responsible for the conduct, safety, or outcomes of the activity. You agree to release and hold harmless YLV, its staff, and affiliates from any claims, damages, or liabilities arising from your child’s participation in the third-party activity.Consent I have read and understood the above information. I give permission for my child to participate in extracurricular activities conducted by a third-party provider on school premises during OSHC hours and accept the terms outlined in this form.Signature*SignatureThis field is hidden when viewing the form Extracurricular Activity Δ
