Privacy Collection Statement

Your personal information is being collected by Wyndham City Council’s Youth Services for the purpose of attending Youth Services. This information will be stored in Council’s database and used to identify you when communicating with the Council, as well as for the delivery of services and information.

By registering your details, you consent to the collection, use and disclosure of your personal information. Your personal information will be handled in accordance with the Privacy and Data Protection Act 2014 (Vic). For further information about how your personal information is handled, please visit Council’s Privacy Policy. 

Young Persons Details
Program Details

For Youth Services program information and locations, please click HERE

Program of interest
Will you be attending an excursion?
Excursion
Fieldtrips and excursions are part of program delivery and will operate under normal supervision and program guidelines and may involve walking or being transported by Council buses/cars to venues inside the municipality. Do you give permission for your young person to be transported by Youth Services staff?
Is your young person allowed to leave an excursion alone? (required)
Authorised to collect the participant

Provide details of authorised person who can collect the participant from the excursion, young person must be physically signed out by parent / guardian.

Emergency Contact
Cultural Diversity
Is the participant of Aboriginal or Torres Strait Islander descent?
Does the participant or their guardian require an interpreter?” (required)
Does the person have any cultural requirements?
Youth Services have a quiet room/sensory room/Prayer room at Youth Services Hoppers Crossing to support all of our community members, is this something that you would like to use?
Dietary Requirements
Do you have dietary requirement? (required)
Additional Requirements
Do you have additional support needs? (required)
Supplementary form
Tick all support need:
Which legal matters do we need to be aware of?
Medical Health Information Form (Asthma)
Maximum 2 files.
10 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Usual signs and symptoms
Worsening signs and symptoms if applicable

1.   Sit the young person down and remain calm to reassure them. Do not leave the young person alone. 

2.   Without delay shake a blue reliever puffer (Airomir, Asmol, Epaq or Ventolin) and give 4 separate puffs through a spacer (use the puffer alone if a spacer is not available). Use one puff at a time and ask the young person to take 4 breaths from the spacer after each puff.  A Bricanyl Turbuhaler may be used in First Aid treatment if a puffer and spacer is unavailable. 

3.   Wait 4 minutes. If there is no improvement, repeat steps 2 and 3. 

4.    If there is still no improvement after a further 4 minutes – call an ambulance immediately (dial 000) and state the young person is having breathing difficulties. Continuously repeat steps 2 and 3 while waiting for the ambulance. 

One file only.
2 MB limit.
Allowed types: pdf, doc, docx, odt, ppt, pptx.
Allergy Action Plan
One file only.
64 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Young person’s awareness of specific triggers
Medical Health Information form (Epilepsy)
One file only.
2 MB limit.
Allowed types: pdf, doc, docx, odt, ppt, pptx.
Awareness of specific triggers
Seizures

Medication Authorisation - Principles 

Wyndham Youth Services staff are not permitted to administer any medications to young people or children attending our programs, events, or services.

Only parents, guardians, or individuals with lawful authority are authorized to administer medication to young people or children during these activities.

Wyndham Youth Services staff are trained in Level 2 First Aid and will provide medical support within the scope of this certification.

Mental Health
Are there any known mental health concerns?
Behavioural Concern
Are there any known behavioural concerns?
Physical Health

Child safe commitment

Wyndham City Council is dedicated to the safety and well-being of all children and young people who participate in our Youth Services Programs. We have zero tolerance for child abuse and are committed to creating a safe, empowering environment where children's voices are heard and respected. The Council has established clear expectations for appropriate behaviour in engaging with children via a Child Safe Code of Conduct. If you have any concerns about a child's safety, please immediately contact our staff, one of our Child Safety Officers or the relevant authorities. Child safety is our highest priority.

Agreement on your Responsibilities and Information
I am (required)

I agree and consent to: 

•  Provide permission for the young person to attend the Wyndham City program or service, 

•   Accept the conditions noted in the section for ‘Responsibilities and Expectations’, read and explained the conditions to the young person (if under 18 years) and they also understand and accept these conditions, 

•  Consent to the collection and use of information as noted in the ‘Privacy Collection Statement’ section, 

•  Accept that when a Power of Attorney is in place, Council will share any personal information about or shared by the young person with the guardian, 

•  Disclose any Power of Attorney arrangements to Council that is entered into while I am accessing Council services. 

I agree and consent to: 

•  I agree to attend the Wyndham City program or service, 

•  I accept the conditions noted in the section for ‘Responsibilities and Expectations". 

•  I consent to the collection and use of information as noted in the ‘Privacy Collection Statement’ section, 

•  I accept that when a Power of Attorney is in place, Council will share any personal information as required, 

•   I will disclose any Power of Attorney arrangements to Council that is entered into while I am accessing Council services. 

Sign above
Back to top