Black Dog Institute : Register

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First Name *

Last Name *

Alternate display name

Email Address *

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Are you under 16? *

Yes

Mandatory risk warning and consent for child to participate

Black Dog Institute provides the following risk warning pursuant to its obligations under the Civil Liability Act, 2002: I acknowledge that I will assume all risks in connection with My/My Child’s participation in Mullets For Mental Health and acknowledge that Black Dog Institute is not liable in respect of these risks materialising or for the breach of any express or implied warranty that services it provides will be provided with reasonable care and skill. I acknowledge that children under 16 years old require consent of their parent or guardian before fundraising for Black Dog Institute. By registering as part of Mullets For Mental Health, I grant permission for My Child who is under 16 years old, to participate in online fundraising through Black Dog Institute, and agree that I will provide supervision of My Child in compliance with the following rules:

Children under the age of 16 using Black Dog Institute’s fundraising services must do so under the supervision of an adult.
Children under the age of 12 using Black Dog Institute’s fundraising services must do so under the direct supervision of an adult.
Children under the age of 6 using Black Dog Institute’s fundraising services must do so under the direct supervision of a parent or guardian.

Parent / Guardian First Name *

Parent / Guardian Last Name *

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Parent / Guardian Phone *

Postal Address

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Mullets For

Mental Health

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Personal Details

Mandatory risk warning and consent for child to participate

Postal Address