Junior Ranger Medical Form

Child's full name*

Event Title*

Event date*

Parent/Guardian Details:

First Name*

Last Name*

Mobile Phone*

Email*

Emergency Contact (in addition to above)

Full Name*

Contact Phone Number*

Medical Details: Please provide details on any medical conditions that may affect your child's ability to participate in any element of the Junior Ranger activity(s) you have registered them for.

Illnesses

Special/Behavioural needs

Allergies

Diet restrictions

If your child will have medication with them at the event, please list the medication and treatment plan associated with the medication. Please provide concise details and ensure you discuss these directly with the Ranger on the event day.

Is your child's tetanus boosters up to date?*

Yes

In the event of an accident or illness, do you agree to your child receiving anaesthetic or blood transfusion?*

Yes

Any other information you may wish to provide

Medical Terms and Conditions for Event participation

As the child's legal parent/guardian I agree and confirm:-

1. Permission is granted to the Ranger, in charge at Walkabout Creek Discovery Centre, to seek
qualified medical treatment and/or ambulance assistance on my behalf where it is considered
necessary for the safety of my child listed on this medical form.
2. That I have read the event terms and conditions when booking and that my child is

1. A) currently within the specified age group required for the Junior Ranger program;
2. B) will have the appropriate clothing, footwear and equipment to participant; and
3. C) is aware of, and I also acknowledge and accept, the general risks associated with
4. physical and/or outdoor activity.
3. Indemnity and Release:
As the child's legal parent/guardian I indemnify the State (which includes the employees and agents of the State) from and against all actions, proceedings, claims, demands, costs, losses, damage and expense which may be brought against or made upon the State, but for this indemnity, as a result of or in connection with, either directly or indirectly, any of the Children’s Activities undertaken by the participant at Walkabout Creek Discovery Centre, which whether with respect to any person or property and the participant’s parent/guardian releases and discharges the State from all such actions, proceedings, claims, demands, costs, losses, damage and expense which might be brought against or made upon the State.

Agreement to the above Terms and Conditions*

Yes

Name of legal parent/guardian accepting terms and conditions*

Privacy: The Department of Environment and Science (DES) is collecting the information on this form for the purpose of conducting junior ranger activities. Information will only be accessed by authorised officers. Some information may be provided to emergency service providers if there is a risk to a person’s health or safety. Personal Information will not be otherwise disclosed to any other third party without your consent, unless authorised or required by law. The department privacy policy can be viewed here. If you have any further queries about our privacy and security practices please contact us at info@des.qld.gov.au.