Over 65s Social Outings Registration Form

Outing Criteria

Over 65 years old*

Yes

A resident of the City of Vincent*

Yes

Independently mobile without aids or assistance*

Yes

Personal Details

Name*

Date of birth*

Address*

Phone number*

Email address*

Emergency contact name and number*

I am responsible for bringing and administering personal medication and agree to inform the bus driver about any medical conditions that are likely to cause distress or discomfort during an outing.

I Agree

I am responsible for maintaining my own safety and well-being during outings and will inform the bus driver about any accidents or incidents that occur.

I Agree

I give consent for any photographs taken during outings to be used for publicity purposes.

I Agree

I would like to be kept informed about other relevant local events.

I Agree

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Over 65s Social Outings Registration Form

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