YELLOW WHEEL COMPANY MEMBER CONTRACT

Full Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Full Name

First Name

Last Name

I/We have read the above conditions and agree *

Yes

Name of Emergency Contact *

First Name

Last Name

PANADOL: I give permission for the appropriate dosage of Panadol to given to my child if it is requested by them. *

Yes

No

Please read the following list and indicate if you have or have had any of the following conditions.

Heart Problems

Respiratory Problems/Asthma

Food Allergies

Drug Allergies

Other Allergies

Diabetes

Recent Illness

Epilepsy

Other

I hereby authorise the Company and/or professional staff to obtain such medical or dental attention as may be deemed necessary, and I understand I am responsible for any associated costs.

Yes

I agree to allow Yellow Wheel to use photographic and video material which may contain my or my child's image, this year and in the future, for the purpose of the content of the work, company marketing, publicity and promotion.

Yes

OR

If photographic permission is not given in the above statement, I understand and agree that I or my child's image may appear in footage of the work, and in the background of images used by Yellow Wheel for promotional and funding purposes. Yellow Wheel however will ensure that I or my child will never be the main subject of a photograph, and will attempt to ensure that I or my child cannot be recognised..

Yes

I understand and agree that I and/or my child retain the right to waive this photographic consent at any point in the future. If this eventuates, I agree that it is my or my child's responsibility to contact Yellow Wheel staff to inform them/the company. *

Yes

I understand that poor and/or inappropriate behaviour may result in I or my child being excluded from the Company. *

Yes