HOMEGROWN

HIGHER HAZARD & RISK WARNING FORM

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 PARTICIPANT.
HOMEGROWN
LETTER TO PARTICIPANTS

Homegrown is our biennial Leadership Conference, and will be held at Mt Tamborine Conference Centre, QLD from Thursday 19th to Saturday 21st January 2023.

We refer to 'Homegrown' which Southern Cross Presbyterian Church is conducting.

We understand that you/your child wishes 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/your child participates in the activity. It is a requirement of the Church and its insurer that before your child undertakes this activity, you complete the Risk Warning and Higher Hazard Risk Event Form below.

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 to you/travel insurance rests with you.

PLEASE NOTE: on Friday 20th January, our children and youth will have the opportunity to participate in Big Group Games run by Vertec - please complete the separate consent form from Vertec Adventure.

In Christ,

Southern Cross Presbyterian Church Staff Team
I have read and understand the 'LETTER TO PARTICIPANTS' for Homegrown Leadership Conference 2023 above.

Yes, I have read and understand the 'LETTER TO PARTICIPANTS' for Homegrown Leadership Conference 2023.
HIGHER HAZARD RISK EVENT FORM
I am completing this form for:*

MyselfMy child
Participant Name*

First Name/sLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Carer Name*

First NameLast Name
Email*
example@example.com
Medical Information and Medical Authority & Consent
I/my child has a medical condition, allergy, asthma, anxiety and/or dietary requirements to be aware of.*

Yes (please provide details 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 the end)*
E.g. 1111 222 333 (5)
Medical Fund
I understand and acknowledge the following:*

I acknowledge the above event (Homegrown 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).
Emergency Contact Information
Emergency Contact*

First NameLast Name
Relationship to participant*
Contact number *
Mobile preferred.
RISK WARNING
In planning Homegrown 2023, the program organisers/leaders have considered the following safety/risk factors including (but not limited to): transport, terrain, sun/wind/insect protection, availability of amenities & drinking water, first aid kit, mobile phone coverage, appropriate registration/permission forms, management of activities, volunteer adults having BTS Safe Ministry training & current WWCC, sleeping arrangements, supervision ratios for the kids' program, event program time table & content, fire safety, food hygiene/safety etc.
I am aware in signing this document for my/my child's participation in Homegrown 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 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. 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, the parent/guardian of the child participant or the participant:*

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.Acknowledge that failure to abide by these guidelines could compromise safety and well-being, other participants and staff and my child would then be directed to leave the Activity.Acknowledge that the warning contained in this document constitutes a risk warning pursuant to the Civil Liability Act 2002.
SIGNATURE
Name*

First NameLast Name
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I would like to sign on the screen below.I would like to upload my signature.
Signature*
Please upload signature here.*

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Today's date*

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HIGHER HAZARD & RISK WARNING FORM

HIGHER HAZARD RISK EVENT FORM

Medical Information and Medical Authority & Consent

Emergency Contact Information

RISK WARNING

SIGNATURE