Whitelion Inc (Stride Programs) Phone 03 8354 0880 www.stride.org.au

ABN: 15 347 659 323

PARENT/GUARDIAN PERMISSION FORM

On the Ball Holiday Program Mount Isa

The On The Ball program is designed to encourage children and young people aged 8-16 years to increase their level of physical activity. Workshops held during the school holidays not only encourage active participation in sport and recreation, but also build general competencies including teamwork, respect for others, goal setting and leadership skills. The program, facilitated by the Stride provides the opportunity for participation in basketball and AFL football activities which are led by former and current elite level players and coaches. The program will be held at the Mount Isa Basketball Stadium, Corner Jessop Drive and Sports Parade. Stride wishes to sometimes utilise photos taken during our programs for promotional purposes. These images may be used in publications, promotional materials, broadcast, print and electronic media. Stride will not use any photo in a manner that may be deemed adverse or defamatory and it will not use the photo for commercial gain. The photo will remain the property of Stride and any personal details associated with this photo will be secure and will not be used for any purpose other than described here. Name of participant: _______________________________________ Name of parent/guardian___________________________________________________

� I permit / do not permit ____________________________to participate in the

On the Ball program.

� I permit / do not permit Stride to use images taken of__________________________ for publications or promotional material.

SIGNED__________________________________________ DATE_________________

For more information about On the Ball, contact Program Manager, Lyn Lenehan on (03) 8354 0880 or email llenehan@stride.org.au.