Leadership 24 - Participant Registration

Leadership 24 - Participant Registration
Welcome to the online participant registration for Leadership 24. You will be asked a series of questions that, upon completion, generates a completed application form.

This year, at the end of the process, the participant as well as the parent/caregiver (if the participant is under 18 years old), will need to sign the form electroncially prior to submission. This will mean you will no longer need to print, sign and return the paper form. Once this is submitted and you have paid the full Course Fee or minimum deposit (which can be done as credit card as part of this process), your application for Leadership 24 is completed.
Stage*
Unfortunately we have reached capacity for Stage 1 applications. If you are interested in attending but have not yet registered, please email bbqldleadership@brigadeaustralia.org to join the wait list.

Registrations for Stage 2 and 3 have now closed.

Participant Full Name*

First NameMiddle NameLast Name
If you prefer to be known by a different first name, please let us know. This will be used as your first name in most Leadership documentation and so should be a preferred name not a nickname.
Is your preferred name different to your first name?*
Preferred Name
Participant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
CurrentDate*

DayMonthYear
Date
Participant Date of Birth*

DayMonthYear
Participants must be in year 10 or older to apply for stage 1.
Age
Participant E-mail*
Please note, this is the primary email address used for all communications in relation to Leadership 23.
Participant Mobile Phone
Format e.g. 0412 000000
Participant Home Phone
Format e.g. 07 22222222
Preferred Method of Contact*

Mobile PhoneHome Phone
BB Company/School/Church *
Name of BB Company/School/Church
The participant's First Name (or Preferred Name), BB Company/School/Church, Email Address, and Preferred Contact Number will be published in the Participant Directory given to all Leadership staff and participants.

Parent/Caregiver Details

Parent/Caregiver 1
Parent/Caregiver 1 Name*

First NameLast Name
Parent/Caregiver 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Caregiver 1 Mobile Phone
Parent/Caregiver 1 Home Phone
Parent/Caregiver 1 Email*
example@example.com
Parent/Caregiver 2
Parent/Caregiver 2 Name

First NameLast Name
Parent/Caregiver 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Caregiver 2 Mobile Phone
Parent/Caregiver 2 Home Phone
Parent/Caregiver 2 Email
example@example.com

Medical Details
Regular Doctors Name*
Regular Doctors Phone Number*
Medicare Number*
Private Health Insurance Provider
Private Health Insurance Membership Number
Does the participant suffer from:

HaemophiliaHeart/Blood ProblemsCystic FibrosisAllergies (Anaphylaxis)AsthmaDiabetesEpilepsy
Medical Condition Further Details
Please provide further details of above medical conditions. A separate Management Plan will be requested with more comprehensive details following Application.
Other Medical Conditions
Outline any other medical conditions excluding those mentioned above (including but not limited to fainting/dizziness, hyper-activity, or hypo-activity).
Has the participant previously broken/fractured any bones?*
Previously broken/fractured bones details*
Recent operations, illnesses, or injuries
Detail any recent operations, illnesses, or injuries (including but not limited to measles, mumps, pneumonia, and tonsillitis)
Year of Last Tetanus Injection/Booster*
Medication
Are you on any regular prescription medications (that you will still be on at Leadership)?*
Include details of all prescription medications taken including drug name, dosage, frequency/times, doctors instructions, and if they are emergency or routine medication. List each drug with details separately.
Prescription Medication
Headaches & Coughs/Colds*
Has participant approval for self-administration of medications?*
This relates to self-administration of prescription or headache/cough/cold medication as outlined above.
Other Details
Do you have any special dietary needs?*
Specific Details of Special Dietary Needs
To enable enable us to provide the best support at Leadership, do you have any special needs we need to be aware of (eg. hearing impairment; sight impairment; anxiety; ADD) ?*
Please provide further details of special needs
Swimming Ability

Emergency Contact Person
This person should be different to the parent/caregiver already listed.

In case of an emergency (medical or other), the parent/caregiver will be the first point of contact. If the parent/caregiver are not contactable, we will contact the following person.
Emergency Contact Person Name*
Emergency Contact Mobile Phone
Emergency Contact Home Phone

Course Costs & Merchandise
The full course fee for Leadership 24 is $550.00. The course fee includes a course shirt.

In addition, participants are able to purchase a number of Leadership items including a cap, beanie, jacket, or reversible vest.

If finances are an issue for you attending Leadership 24, please speak to your company captain in the first instance as we do not want people missing out due to finances.
Shirt Size*
Optional: Beanie
Would you like to order a Leadership Beanie at a cost of $15.00?*
Beanie Cost
Optional: Cap
Would you like to order a Leadership Cap at a cost of $15.00?*
Cap Cost
Optional: Reversible Vest
Would you like to purchase a reversible vest at a cost of $45.00?*
Vest Cost
Size
Colour
Optional: Polar Fleece Jacket
Would you like to purchase a Navy polar fleece jacket at a cost of $35.00?*
Jacket Cost
Size
Colour

Payment Details
A non-refundable deposit is required to be paid to finalise your application. This is $250.00 plus the cost of any additional items of merchandise you may have ordered.

This deposit (or the full course fee) can be paid now via credit card, or via direct deposit, cash, or cheque at a later stage.

Please note, we do not accept payments at the course and the full payment need to be received by Thursday 13 June 2024.
Would you like to pay deposit now credit card?*
Alternatively payment of the deposit can be made via direct deposit, cheque, or cash following submission of the application.
Full Cost
Deposit
Would you like to pay deposit only or full fee?
To Pay
Payment Processing Fee
Full Amt inc Fee
As of 1 February 2020, The Boys’ Brigade Queensland has made the decision to pass on the 1.4% credit card processing fee for credit card payments. The “Payment Amount” (below) includes this payment processing fee of ${paymentProcessing}.

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Agreement and Consent
Participant Agreement (under 18 years)

To be read and agreed by the participant
1. To fully participate in the Course program;
2. To maintain an appropriate standard of conduct at all times;
3. Not to bring any electronic devices including mobile phones, tablets, or GPS devices.
4. Not to bring or use alcohol or other drugs whilst at Leadership.
Participant Agreement (over 18 years)

To be read and agreed by the participant (over 18 years)
1. Agree to fully participate in the Course program;
2. Agree to maintain an appropriate standard of conduct at all times;
3. Agree not to bring any electronic devices including mobile phones, tablets, or GPS devices.
4. Agree not to bring or use alcohol or other drugs whilst at Leadership.
5. Agree to pay the full Course Fee of $550.00 (plus any merchandise ordered) with deposit due on application and full Course Fee due by 13 June 2024.
6. Authorise the Leadership Course staff, Boys’ Brigade officers, its servants or agents, in the event of an accident, injury, illness or loss suffered by myself whilst participating in any aspect of the Course, to obtain any necessary medical assistance or treatment including, but not limited to, engaging any doctors, nurses or hospital accommodation.
7. Acknowledge the information provided on all parts of this Participant Application are accurate and complete.
8. Request that the medication as specified on the medical form be administered, or assistance be provided in the management of the medication, in accordance with the instructions provided.
9. Consent to pay all such doctors, nurses or hospital accommodation fees and expenses incurred on my behalf as a result of any such accident, injury, illness or loss suffered by me whilst participating in any aspect of the Leadership Course.
Participant Signature

Clear
For the participant to sign in the box above, using your mouse or touch pad to, confirming agreement with the terms and conditions.
Signed by Participant (name)
Parent/Caregiver Agreement

To be read and agreed by a parent/caregiver
1. Agree to pay the full Course Fee of $550.00 (plus any merchandise ordered) with deposit due on application and full Course Fee due by 13 June 2024.
2. Authorise the Leadership Course staff, Boys’ Brigade officers, its servants or agents, in the event of an accident, injury, illness or loss suffered by {participantFullName} whilst participating in any aspect of the Course, to obtain any necessary medical assistance or treatment including, but not limited to, engaging any doctors, nurses or hospital accommodation.
3. Acknowledge the information provided on all parts of this Participant Application are accurate and complete.
4. Request that the medication as specified on the medical form be administered, or assistance be provided in the management of the medication, in accordance with the instructions provided.
5. Consent to pay all such doctors, nurses or hospital accommodation fees and expenses incurred on my behalf as a result of any such accident, injury, illness or loss suffered by {participantFullName} whilst participating in any aspect of Leadership.
Parent/Caregiver Signature

Clear
For the parent/caregiver to sign in the box above, using mouse or touch pad to confirm agreement with the terms and conditions.
Signed by Parent/Caregiver (name)
Photos,videos, and sound recordings will be taken throughout Leadership 24 to be used as part of daily videos and other material.

If you do not agree to you/your son's appearing in photos, videos, or sound recordings for Leadership and other Brigade related promotional purposes, please email bbqldleadership@brigadeaustralia.org including their name and a current photo of him stating you do not wish for him to be captured and we will endevour to ensure he is not included in these photos, videos, or sound recordings.
Should be Empty:

Leadership 24 - Participant Registration

Parent/Caregiver Details

Medical Details

Medication

Other Details

Emergency Contact Person

Course Costs & Merchandise

Payment Details

Agreement and Consent

Participant Agreement (under 18 years)

Participant Agreement (over 18 years)

Parent/Caregiver Agreement