ADULT PARTICIPANT - YAWA 2023

ADULT PARTICIPANT - YAWA 2023 REGISTRATION

In line with our commitment to safe ministry practices, the information collected in this form will be used by appointed program leaders and stored securely by Southern Cross Presbyterian Church. PLEASE COMPLETE ONE FORM PER ADULT.
LETTER TO ADULT PARTICIPANTS
Dear Young Adults,

We refer to the Young Adults Weekend Away (YAWA) on August 11-13, 2023 which Southern Cross Presbyterian Church is conducting.

We understand that you wish to attend this activity. There are certain risks inherent in this activity and it is important that we draw these to your attention before you participate in the activity. It is a requirement of the Church and its insurer that before you undertake this activity, you complete the form below.

Please complete the form below by Sunday August 6. Please note that we will observe strictly the requirement, no form, no attendance.

Please note that the obligation to take out insurance to cover personal injury/travel insurance rests with you.

Yours sincerely,

Stew Playsted
Vision, Leadership & Community Pastor
I have read an understood the 'Letter to Adult Participants'.*

Yes, I have read an understood the 'Letter to Adult Participants'.
PARTICIPANT INFORMATION
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any dietary requirements?*

Yes (if 'yes' please outline below)No
Please outline your specific dietary requirements here:
MEDICAL INFORMATION & MEDICAL AUTHORITY CONSENT
I have a medical condition, allergy, asthma and/or anxiety.*

Yes (if 'yes' please outline below)No
Please provide specific details about condition, allergy, asthma, anxiety etc.(including severity, regular medications and treatment/management). *
Medicare Number (include position on card in brackets at end)*
Medical fund
As an adult participant I understand and acknowledge the following:*

I acknowledge the above event (Young Adults Weekend Away 2023) entails certain risks inherent in this type of activity. I also acknowledge the Organisation and its helpers will make every reasonable effort to ensure the safety of the participant which may attract injury or loss.I authorise the Organisation to arrange immediate medical attention or treatment, including surgery and/or administration of anaesthetics as the case may require, or is likely to require. Such treatment will be authorised in writing or otherwise.I accept responsibility for payment of any expenses incurred, including transportation.I also acknowledge the Risk Warning constitutes a risk warning pursuant to the Civil Liability Act 2002 (including any amendments).I acknowledge and accept that there is a risk that I may be exposed to COVID-19 whilst attending and participating in YAWA 2023. I confirm that I will not attend if displaying any symptoms of illness.I understand that should I develop flu-like symptoms a rapid antigen test (RAT) will be provided for me to administer.I acknowledge that should I test positive whilst at YAWA 2023, OR if I do not undertake a RAT, I will be required to leave YAWA 2023.
EMERGENCY CONTACT INFORMATION
Emergency contact*

First NameLast Name
Relationship to you*
Phone Number*
Mobile preferred.
RISK WARNING
In planning the Young Adults Weekend Away 2023, the program leaders have considered the following safety/risk factors, including but not limited to: transport, terrain, sun/wind/insect protection, availability of toilets/drinking water, first aid kit, mobile phone coverage, hazard/risk/permission note with medical info for each participant, management of activities, sleeping arrangements, fire safety, food hygeine/safety etc.
I am aware in signing this document for my participation in the Young Adults Weekend Away 2023 ('the Activity'), that certain elements of the Activity may be physically and/or emotionally demanding. I acknowledge that in providing me with this document, the Organisation has warned me that certain inherent physical and/or emotional risks and dangers may exist in the Activity. I acknowledge that while the Organisation and its staff/leaders will make every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities (including but not limited to the risks identified in the Schedule above) cannot be foreseen or may be beyond the control of the Organisation and staff/leaders. I agree that I understand the general nature of these risks may include physical injury and/or bodily injury including injuries that may be fatal; psychological injury, stress and or emotional distress; and associated trauma; howsoever caused.*

I understand.
By signing at the end of this form*

I agree to abide by any safety guidelines and/or written and/or verbal instructions in relation to the Activity as established by the Staff of the Organisation in charge for the duration of the Activity.I acknowledge that failure to abide by these guidelines could compromise safety and well-being, other participants and staff and I may be directed to leave the Activity.I acknowledge that the warning contained in this document constitutes a risk warning pursuant to the Civil Liability Act 2002.
SIGNATURE
Name*

First NameLast Name
Please select from the following:*

I would like to sign on the screen below.I would like to upload my signature.
Please sign on the screen here:*
Please upload signature here:*

Cancelof
Date*

DayMonthYear
Date
FOOD

You will need to make your own food arrangements for the weekend (bring your own, or buy there), with the exception of Saturday dinner which will be a sausage sizzle provided. You are invited to meet at Harwood Pub on the Friday night for dinner at 6pm, but a booking will need to be made, so please indicate below if you will attend.
Will you be attending dinner at Harwood Pub on Friday 11th August at 6pm?*

Yes! Count me in, I'll be thereNo, I won't be there by then and will make my own dinner arrangements
ACCOMMODATION

The cost of YAWA 2023 covers the cost of the whole site that has been booked for YAWA use, along with some food and speaker expenses. There is one registration amount (early bird or after), however attendees may choose which accommodation they would prefer: cabin or camp in swags/tents. Please select your accommodation below.
Accommodation
If camping, please select which option you will be bringing:

TentSwagI'm not camping, I've selected cabin
PAYMENT

YAWA PAYMENT

Full RegistrationFor registration after 30th July.

$100.00AUD

Enter coupon

Total

$0.00AUD

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

ADULT PARTICIPANT - YAWA 2023 REGISTRATION

LETTER TO ADULT PARTICIPANTS

PARTICIPANT INFORMATION

MEDICAL INFORMATION & MEDICAL AUTHORITY CONSENT

EMERGENCY CONTACT INFORMATION

RISK WARNING

SIGNATURE

FOOD

ACCOMMODATION

PAYMENT