10-19 years Cross Country Student name: Age: I am aware that my name, personal information (i.e. DOB, school attending) and image may be used (as child’s outlined below) by the host State / Territory in a variety of ways to promote the representative school sport program. Event Specific Information: Please if you consent to the sharing / publication of your personal information as detailed circle ‘YES’ son’s below, and if you do not consent to the sharing / publication of your personal information as ‘NO’ son’s detailed below. I understand that if I have any concerns regarding consent for my name or personal details being used for any child’s purpose listed above I will contact the team manager immediately. I understand that it is not compulsory for me to provide this consent and if consent is not provided my decision will not adversely affect my position on the team. child’s Signed By: (name) (Parent / Caregiver name) Signature: Date:
10-19 years Cross Country Student name: Age: I am aware that my child’s name, personal information (i.e. DOB, school attending) and image may be used (as outlined below) by the host State / Territory in a variety of ways to promote the representative school sport program. Event Specific Information: Please circle ‘YES’ if you consent to the sharing / publication of your son’s personal information as detailed below, and ‘NO’ if you do not consent to the sharing / publication of your son’s personal information as detailed below. I understand that if I have any concerns regarding consent for my child’s name or personal details being used for any purpose listed above I will contact the team manager immediately. I understand that it is not compulsory for me to provide this consent and if consent is not provided my decision will not adversely affect my child’s position on the team. Signed By: (name) (Parent / Caregiver name) Signature: Date: