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* 1. Date of Registration

Date

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* 2. Full Name (First and Last Name)

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* 3. Young Person's Details

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* 4. What is your age?

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* 5. What is your gender?

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* 6. What school do you attend?

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* 7. Which ethnicity best describes you? (Choose more than 1 if needed)

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* 8. Which REKON location are you attending today?

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* 9. Do you have any medical conditions, allergies, or health needs that requires medication or a care plan while you’re at REKON?

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* 10. What do want to do at REKON? (Tick more than 1 box)

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* 11. Which activity would you like to participate in at REKON?

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* 12. What other activities would you like to do?

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* 13. Parent/Guardian Details

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* 14. MEDIA RELEASE AGREEMENT

By completing and submitting this form, you (the "Participant") acknowledge and agree to the following terms regarding the use of your responses, images, videos, or any other media submitted in connection with REKON Youth Programs:
  • Grant of Permission: You grant REKON Youth Foundation, its affiliates, agents, and assigns the right to use, reproduce, distribute, and display your survey responses, photos, videos, and/or other content submitted in any media (whether now known or later developed), without any further consent, notification, or compensation to you.
  • Use of Media: The media may be used for promotional, educational, or commercial purposes, including but not limited to publications, websites, social media, presentations, and other marketing materials.
  • No Compensation: You acknowledge that you will not receive any compensation, monetary or otherwise, for the use of your survey responses, images, videos, or other content.
  • Rights of Use: You represent that you have the legal right to grant these permissions, and that your responses or submitted media do not infringe on the intellectual property or privacy rights of any third party.
  • Waiver of Liability: You agree to release and hold harmless REKON Youth Foundation, its directors, officers, employees, and agents from any claims, damages, or liabilities arising out of the use of your responses or submitted media as outlined in this agreement.
  • Consent Confirmation: By submitting this form, you confirm that you have read, understood, and agreed to the terms of this Media Release Agreement.

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* 15. RISK WAIVER AND AGREEMENT

By registering for this activity, I acknowledge and understand that participation involves certain inherent risks, including the possibility of injury or harm. I agree to assume all risks associated with my participation.

I hereby release and hold harmless REKON Youth Foundation, its staff, volunteers, and agents from any liability for any injury, accident, or damage that may occur as a result of participation. In case of emergency, I authorise the staff to seek medical treatment if necessary, and I accept full responsibility for any medical expenses incurred.

By checking the box below and submitting this registration, I confirm that I have read and understood this waiver and agree to its terms.

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