Rise: For Such a Time as This - Ablaze Camp 2014 Registration Form

$175 NORMAL TILL 31 AUG

$185 LATE TILL 28 SEPT

S E C T I O N A - R E G I S T R AT I O N

PERSONAL DETAILS Full name Date of Birth Address Suburb Postcode Ph Mobile Email

EMERGENCY CONTACT DETAILS Full name Ph Mobile Relation to delegate

MEDICAL HISTORY Special dietary requirements Medical conditions Allergies Regular medication Medication administration details

SECTION B - CONDITIONS

PAYMENT CONDITIONS Registration will be forfeited if the following conditions are not met: 1.

This form and full registration fee must be handed in together to the registration coordinators 2.

Cash payment only For more information, visit the Facebook event For Such A Time As This

CANCELLATIONS We understand that people’s circumstances can change and provide the following alternatives to assist you. Cancellations or transfers (subject to availability) can be arranged, by contacting the Ablaze Ministries International office before 28th September 2014. You are able to transfer your registration (only once) to another person at no extra cost. Please note that refunds are not available for transferred registration. From time to time, there may be a need for special consideration of your circumstances in regards to this policy. If this is the case, please contact our office to discuss this futher. Your registration and payment confirm that you have accepted this policy.

SECTION C - UNDER 18 YRS

PARACETAMOL CONSENT I hereby give permission for First Aid Staff/St John’s Ambulance to administer paracetamol to my child if deemed necessary by the staff.

Please select an answer Yes

No

MEDICAL TREATMENT CONSENT I being the parent/guardian of the said child understand that whilst every precaution will be taken to ensure the good welfare and protection of my child, Ablaze Ministries International and Hope Church Brisbane, its staff and volunteers acting on its behalf are hereby released from any and all liability in the event of any accident or misfortune, damage or loss that may occur to the child and their property. I hereby give permission to the First Aid Staff/St John Ambulance to ensure proper treatment for my child. I understand that every effort will be made to contact me before instituting such procedures. I agree to pay all such doctor, ambulance and hospital fees incurred on behalf of my child. I hereby give permission for Ablaze Ministries International and Hope Church Brisbane to obtain emergency medical, hospital or ambulance assistance at any time they consider necessary.

Please select an answer Yes

No

INVOLVEMENT CONSENT I being the parent/guardian of the said child hereby give my consent that my son/daughter may participate in any activities they choose over the course of Ablaze Camp 2014, whether its games, jumping castles, basketball, skateboarding etc.

Please select an answer Yes

No

PERMISSION TO BE PHOTOGRAPHED OR FILMED I being the parent/guardian of the said child give my consent for Ablaze Ministries International and Hope Church Brisbane to collect information about my child for administrative purposes. I give my permission for my child to be photographed or videotaped. I understand that the image may be displayed in the church publications, church buildings or website. I understand that as a precaution my child’s name will not be published or linked with photographs. As a condition of participation in Ablaze Camp 2014 my child will comply with rules and instructions given by the campsite and camp coordinators.

Please select an answer Yes

No

SECTION C - UNDER 18 YRS CONT

TRANSPORTATION CONSENT I hereby give permission for the transportation of my child via private vehicles to and from the venue that will be used by Ablaze Camp 2014. I further indemnify Ablaze Ministries International and Hope Church Brisbane, their staff and volunteers from any accident, loss of belongings, injury or death that may arise while transporting my child to and from the venue.

Please select an answer Yes

No

LIABILITY WAIVER I, being the parent/guardian of the said child, understand that whilst every precaution will be taken to ensure the good welfare and protection of my child, Ablaze Ministries International and Hope Church Brisbane, its staff and volunteers are hereby released from any and all liability in the event of an accident or misfortune, damage or loss that may occur to the child and/or their property while present at Ablaze Camp 2014.

Please select an answer Yes

DELEGATE’S DECLARATION PARENTS SIGN IF DELEGATE IS UNDER 18 Delegate Declaration: I hereby declare that provided information is true.

Date:

/

/

Delegate Name:

Delegate’s Signature Delegate’s Contact Phone During Camp

No

S E C T I O N D - 1 8 Y R S & A B OV E

PARACETAMOL CONSENT I hereby give permission for First Aid Staff/St John’s Ambulance to administer paracetamol if deemed necessary by the staff.

Please select an answer Yes

No

MEDICAL TREATMENT CONSENT I understand that whilst every precaution will be taken to ensure my good welfare and protection, Ablaze Ministries International and Hope Church Brisbane, its staff and volunteers acting on its behalf are hereby released from any and all liability in the event of any accident or misfortune, damage or loss that may occur to me and my property. I hereby give permission to the First Aid Staff/St John Ambulance to ensure proper treatment. I understand that every effort will be made to contact my emergency contact before instituting such procedures. I agree to pay all such doctor, ambulance and hospital fees incurred. I hereby give permission for Ablaze Ministries International and Hope Church Brisbane to obtain emergency medical, hospital or ambulance assistance at any time they consider necessary.

Please select an answer Yes

No

PERMISSION TO BE PHOTOGRAPHED OR FILMED I give my consent for Ablaze Ministries International and Hope Church Brisbane to collect information about me for administrative purposes. I give my permission to be photographed or videotaped. I understand that the image may be displayed in the church publications, church buildings or website. I understand that as a precaution my name will not be published or linked with photographs. As a condition of participation in Ablaze Camp 2014 I will comply with rules and instructions given by the campsite and camp coordinators.

Please select an answer Yes

No

TRANSPORTATION CONSENT I hereby give permission for my transportation via private vehicles to and from the venue that will be used by Ablaze Camp 2014. I further indemnify Ablaze Ministries International and Hope Church Brisbane, their staff and volunteers from any accident, loss of belongings, injury or death that may arise while transporting me to and from the venue.

Please select an answer Yes

No

S E C T I O N D - 1 8 Y R S & A B OV E C O N T

LIABILITY WAIVER I understand that whilst every precaution will be taken to ensure my good welfare and protection, Ablaze Ministries International and Hope Church Brisbane, its staff and volunteers are hereby released from any and all liability in the event of an accident or misfortune, damage or loss that may occur to me and/or their property while present at Ablaze Camp 2014.

Please select an answer Yes

DELEGATE’S DECLARATION PARENTS SIGN IF DELEGATE IS UNDER 18 Delegate Declaration: I hereby declare that provided information is true.

Date:

/

/

Delegate Name:

Delegate’s Signature Delegate’s Contact Phone During Camp

No