Parent / Carer Authority, Consent and Release – JCU Work Experience
I consent to my son/daughter __________________________________ attending James Cook University for the
purposes of obtaining work experience (“the Work Experience”).
Exclusion of Liability Provision
• Whilst JCU will take all reasonable care to avoid injury to persons or damage to or loss of property during the Work
, JCU will not be liable for personal injury or property loss or damage of any kind whatsoever.
• I confirm that I have read the exclusion of liability provision (see above paragraph) and by signing this Form
release JCU and its employees, contractors, agents and successors in title free from any and all liabilities,
claims or actions whatsoever or however caused, arising as a result of or in connection with, directly or
indirectly, my child’s participation in the Work Experience.
Accident, Illness or Damage
• In the event of an accident or illness, I give permission for JCU employees to obtain or administer any medical
assistance or treatment that my child may reasonably require. Should this be necessary, I understand that I will be
notified as soon as possible and I accept liability for all reasonable costs incurred by JCU in obtaining such medical
assistance or treatment (including any transportation costs) and undertake to reimburse JCU the full amount of those
• I agr
ee that if my child demonstrates any behaviour that is disruptive or negative in the opinion of JCU during the
Work Experience, I will accept the early return of my child and will collect my child from the campus at my own
agree that my child will be required to observe all directions given by JCU supervisors with respect to safety, the
use of JCU equipment and facilities and interaction with other persons (including other students) during the Work
• I agree to compensate JCU and any other owner of property for any damage that my child willfully or negligently
causes to their property during the Work Experience.
e of Photographs and/or Video/Digital Footage
• I understand that JCU and/or your school may wish to take photographs and/or video/digital footage (“the Images”)
f my child participating in the Work Experience, to store those Images and to use those Images in the promotion
of the Work Experience and JCU and Northern Beaches State High School.
By signing this Form, I give permission for JCU and/or your school to take Images of my child
participating in the Work Experience and to use the Images in the promotion of the Work
Experience and JCU and your school generally on TV, radio or in newspapers, in trade and other journals
and on the internet.
gned: _____________________________ Date:___________________
______________________________ (Mother/Father/Carer) Telephone: __________________
Does your child have any medical requirement (please circle)? Yes No
Yes provide details:
James Cook University (JCU) is collecting the personal information requested in this form in order to:
- obtain lawful consent for your child to participate in the Work Experience;
- help coordinate the Work Experience;
- respond to any injury or medical condition that may arise during, or as a result of the Work Experience;
- for the other purposes set out in this form.
The information will only be accessed by authorised JCU employees and contractors and will be dealt with in accordance with the requirements
of the Information Privacy Act 2009 (Qld).
The information will not be disclosed to any other person or agency unless it is for a purpose stated above, the disclosure is authorised or
required by law, or you have given JCU permission for the information to be disclosed.
Your rights to access and amend your personal information are set out in the Information Privacy Act 2009 (Qld) which also places obligations
on JCU as to how we handle your personal information. For further information concerning privacy please direct your inquiries to Division of
Tropical Health and Medicine at email@example.com.