HERE ME

1

DATE

Workshop — Friday 1st October.
Flashmob event — Saturday 2nd October.

TIME

Workshop — 10am to 2:30pm (lunch provided)
Flashmob — 9.30am and 11.30am (TBC)

ADDRESS

Meet at Mount Evelyn Community House

50 Wray Cres, Mount Evelyn VIC 3796

Clicke here for map.

2

Name of Participant* This field is required.Full name

First Name

Last Name

3

Year Level* This field is required.

4

School* This field is required.

5

Mobile Number* This field is required.Your mobile number, not your parent/guardian

6

Any allergies, medical conditions or special needs?just good to know these things

7

Lunch will be provided on the Friday, please let us know of any dietary requirements.

8

Parent/guardian name and contact* This field is required.Full name and mobile number

9

Parent email contact* This field is required.So we can send you pictures from the event

10

Any questions or important information we need to know?

11

We will be monitoring the COVID situation and maintain prescribed Government guidelines. Scheduled cleaning will take place, hand sanitizer provided, and mask rules at the time adhered to when indoors and can't socially distance. As the nature of the workshop does involve close contact your written consent is required. Parent consent - As the parent/guardian, I give my permission for him/her/them to participate in the HERE ME youth art project. I understand the activities involved and the 2-day commitment required.* This field is required.A text message will be sent to verify and confirm your consent

YESNO

12

HERE ME - photo and video consent - Parent Form* This field is required.HERE ME is a youth arts project funded by the Yarra Ranges Council. Your child may be photographed or filmed as part of their participation in this activity. You do not need to do anything in response, participation is voluntary and copies of the images can be provided upon request. Images taken will document the delivery of the project for internal record keeping and may be used by Yarra Ranges Council exclusively for promoting future youth programs and events where appropriate. This may include: • • •Print materials including newsletters, posters, brochures etc •Digital Media including websites, social media, online advertising Contact Yarra Ranges Council on 9294 6905 or mail@yarraranges.vic.gov.au for more information regarding our use of photos and personal information if you have any questions, concerns or wish to withdraw your consent at anytime. *If you do not want your child’s photo taken and used as described above; please type DO NOT GIVE CONSENT in the box below.

Parent/guardian’s FULL NAME and DATE

13

How did you hear about the project?* This field is required.school newsletter, class presentation, poster, FB, other?

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Thank you for submitting your application! As places are limited, you will be notified to confirm your place and participation in the project. We look forward to collaborating with you and making some cool stuff happen in the streets on Mount Evelyn!