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Please fill in the information below completely:

FAK Youth Symphony Orchestra member full name and surname: *

ID number: *

Parent/guardian full name and surname: *

Parent cellphone number: *

Parent email address: *

1. I hereby permit my child, as a member of the FAK Youth Symphony Orchestra, to attend the camp from 14-16 March at FAK Udolpho Rivierplaas in Parys.

2. I accept that all reasonable precautions will be taken for the safety and well-being of my child and that I will be held responsible for the payment of medical and/or hospital bills, if applicable, in the event of an injury that cannot be attributed to the negligence of the responsible staff.

3. I transfer my powers as parent/guardian to the representative of the FAK if medical treatment or surgical intervention may be necessary for my child. As far as I know, he or she is physically able to participate in the mentioned activities and is in good health.

4. However, I request that the responsible persons pay attention to the following: (Special attention that the learner would need).

Write special requests here:

Medical Aid Information:

The following information is essential in case of medical treatment or hospitalisation.

Name of medical aid: *

Medical aid number: *

Main member initials and surname: *

Main member ID number: *

Name of employer: *

Address of employer: *

Address of parent/guardian: *

Parent/guardian telephone number: Home

Parent/guardian telephone number: Work

Parent/guardian telephone number: Cellphone *

I request that the responsible persons pay attention to the following: (Please name aspects of which we must be aware, e.g. allergies, special medications, special dietary preferences, etc.)

Write requests here:

Medical aid card and copy of main member ID (uploads must nog exceed 1mb) *

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Alternative Contact Person:

Name and surname: *

Cellphone number: *

I hereby give permission for photos of my child to be taken and used for social media and sent to the media: *

It's a privilege to be part of the FAK Youth Symphony Orchestra, but with every privilege comes a responsibility to abide by the rules. If the responsibility is disregarded, the member will lose the privilege of continuing to be part of the FAK Youth Symphony Orchestra. The member hereby undertakes to adhere to the terms and conditions.

Disclaimer:

1. By making your and your child’s personal information available to the FAK:
1.1. You agree that your and your child's information, as requested on this form, is collected by the FAK and stored, processed and preserved on the Kultuurtuiste Group’s hardware and software.
1.2. You agree that your personal information may be used for direct marketing (whether verbally, by telephone, in writing or any other form) of any of the FAK’s offers and promotions.

2. If you wish to change, update or delete any of your personal information, an e-mail can be sent to the Information Officer of the FAK at willem@kultuurtuiste.org.za.

3. If you have any complaint in relation to how your personal information is collected, processed and/or stored by the Voortrekker Monument Group, such complaint can be sent to the Information Officer of the FAK at willem@kultuurtuiste.org.za.

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