Youth Programs Application Form 2026

Participant Details

Parent / Guardian Details

Youth Code of Conduct

I agree to behave in a safe, respectful, and inclusive manner while participating in any Shire of Capel Youth Services program, activity, event, or excursion.

I will not:
• Bully, harass, exclude, or intentionally upset others, including through name-calling, rumours, or inappropriate behaviour.
• Use racist, discriminatory, sexual, offensive, or abusive language.
• Display violent, threatening, or aggressive behaviour.
• Damage property, vandalise spaces, or misuse equipment.
• Take or use property that does not belong to me without permission.
• Bring or use alcohol, illicit substances, weapons, or attend under the influence of any substance.
• Engage in any behaviour that places myself or others at risk.

Youth Services staff will respond to inappropriate behaviour using a staged warning process where appropriate. Serious incidents may result in an immediate removal from the program, parent/guardian contact, suspension from Youth Services programs, or involvement of police where required.

I understand that breaches of this Code of Conduct may result in being asked to leave a program, event, or activity and may affect my ability to participate in future Youth Services programs.

Parent/Guardian Declaration

I understand that the Shire of Capel’s duty of care applies only during the scheduled program, activity, event, or excursion times and ends at the conclusion of the session unless otherwise advised.

I agree to:
• Remain contactable for the duration of the program or activity.
• Arrange collection of my young person if required due to illness, injury, behaviour, or other circumstances.
• Ensure my young person is a willing participant and understands they are expected to follow staff instructions and the Youth Services Code of Conduct.
• Notify Youth Services as soon as possible if my young person is unable to attend a session or activity.

I acknowledge that Youth Services programs are designed to provide a safe, inclusive, and positive

Medical Declaration

I understand that Youth Services staff and facilitators are not medical practitioners and are only able to provide basic first aid within the scope of their training.

I acknowledge that my young person is expected to participate safely, follow staff instructions, and take reasonable care for their own wellbeing and the wellbeing of others.

In the event of an illness, injury, or medical emergency, I authorise the Shire of Capel to seek appropriate medical treatment for my young person, including contacting emergency services and arranging ambulance transport if required.

Photo Consent Declaration

I give permission for the Shire of Capel to photograph and/or film my young person during Youth Services programs, activities, events, and excursions.

I understand these images may be used for promotional, educational, community engagement, and reporting purposes, including on the Shire of Capel website, social media, printed materials, presentations, and internal documents.

I understand that:
• Participation in photos or videos is voluntary, and my young person can choose not to be photographed at any time.
• Images will be used respectfully and young people will not be identified by full name without additional consent.
• Images will be stored and managed in line with the Shire of Capel’s Child Safety and Wellbeing Policy and relevant privacy requirements.
• Consent may be withdrawn at any time by contacting the Shire of Capel.
• Where possible, Shire-issued devices will be used to capture images and video.