State Junior's Camp Registration

State Junior's Camp 2024 Registration
When: 8:00pm 15th - 12:00pm 17th November 2024
Where: Noosa Outdoor Education Centre, 761 McKinnon Drive COOROIBAH Qld 4565
Who: Junior Boys (8-11 years old & their Officer's)
Cost: $97 per person + $12 for optional BB Bucket Hat. Early Bird discount applies if payment is made in full before 18 October bringing cost down to $85 per person.

Registrations & Payments close on 1st November

For further information including what to bring, download the SJC Information Sheet
Registration Type*

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 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
Age
BB Age*
E-mail*
Mobile Phone
Home Phone
Preferred Method of Contact*

Mobile PhoneHome Phone
BB Company*
If your BB Company is not listed, it is likely they have not yet registered to participate. Please check with your Captain in the first instance.

Leader Registration
Are you currently a registered Leader with BB?*
BB Company*
Name of BB Company/School/Church*
Which Church do you currently attend?*
Working with Children Blue Card
Do you hold a current Working with Children Blue Card or Exemption Card?*
Blue/Exemption Card Number*
Please include (exemption) after your Blue Card Number if you hold an Exemption Card not a Blue Card.
Card Expiry*

DayMonthYear
Date

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.
Other Medical Conditions
Outline any other medical conditions excluding those mentioned above.
Recent operations, illnesses, or injuries
Detail any recent operations, illnesses, or injuries.
Year of Last Tetanus Injection/Booster
Medication
Is the participant on any regular prescription medications (that they will still be on at the event)?*
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
Does the participant have any special dietary needs?*
Specific Details of Special Dietary Needs
To enable enable us to provide the best support at the event, does the participant have any special needs we need to be aware of (eg. hearing impairment; sight impairment; anxiety; ADD) ?*
Please provide further details of special needs
Does participant currently suffer from bed wetting?*
How would you rate the participant's swimming ability?*

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

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

Payment Details
Cost for State Junior's Camp is $97 per participant or $85 if paid in full before 18th October 2024.

This can be paid now via credit card, or via direct deposit, cash, or cheque with full payment required by 1st November 2024. For earlybird discount to apply, full payment is required by 18th October 2024.
As a leader, a subsidised rate of $75 per leader applies with payments due by 1st November 2024.
Would you like to purchase a BB Bucket Hat at a cost of $12?*
Bucket Hat Size*
Would you like to pay now via credit card?*
Alternatively payment of the deposit can be made via direct deposit, cheque, or cash following submission of the application.
Course Cost
Hat Cost
Full Cost
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
Do you give consent for photographs, videos or sound recordings of {participantFullName} produced during this activity being used for promotional purposes?
Participant Agreement (over 18 years)

To be read and agreed by the participant (over 18 years)
As a participant who is over 18 years old:
1. I have provided The Boys’ Brigade QLD with all current information relating to {participantFullName} including any special medical management details; details of all known allergies (drugs, foods, insects, etc.) and allergic reaction management forms; details of recent operations or injuries; details of current prescription medication and administration; and any special dietary requirements.
2. I am aware that this activity may be challenging both physically and emotionally and realize that, in spite of the planning processes of the group, members may experience situations where they encounter unpredictable and unforeseen risks and acknowledge, despite precautions and supervision, accidents may happen.
3. I give permission for {participantFullName} to attend and take part in the activities or event described above. I understand that in the event of any illness or accident, every effort will be made to contact me, but if this is not possible, I authorize any Leader to sign on my behalf, any written form of consent required by medical providers (including the administration of anesthetic if required) and accept all associated costs.
4. I understand that the information collected on this form will be used for the purposes of fulfilling the Boys’ Brigade Australia’s objectives and duty of care for {participantFullName} and will be treated securely and not be passed on for commercial purposes.
5. I acknowledge that prescription medications can only be administered by a leader if written permission has been and that all medications will be kept in their original packaging showing clearly the pharmacy label containing all required information.
6. I declare that the information provided in this application is complete and correct and is based on advice provided by a medical practitioner.
7. I agree to pay the full fees by the closing date of 1st November 2024 (or 18th October for earlybird pricing to apply).
In addition, as a leader:
1. I have read and agree to the Boys' Brigade Australia - Code of Conduct for Leaders.
Participant Signature

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

To be read and agreed by a parent/caregiver
As a parent/caregiver:
1. I have provided The Boys’ Brigade QLD with all current information relating to {participantFullName} including any special medical management details; details of all known allergies (drugs, foods, insects, etc.) and allergic reaction management forms; details of recent operations or injuries; details of current prescription medication and administration; and any special dietary requirements.
2. I am aware that this activity may be challenging both physically and emotionally and realize that, in spite of the planning processes of the group, members may experience situations where they encounter unpredictable and unforeseen risks and acknowledge, despite precautions and supervision, accidents may happen.
3. I give permission for {participantFullName} to attend and take part in the activities or event described above. I understand that in the event of any illness or accident, every effort will be made to contact me, but if this is not possible, I authorize any Leader to sign on my behalf, any written form of consent required by medical providers (including the administration of anesthetic if required) and accept all associated costs.
4. I understand that the information collected on this form will be used for the purposes of fulfilling the Boys’ Brigade Australia’s objectives and duty of care for {participantFullName} and will be treated securely and not be passed on for commercial purposes.
5. I acknowledge that prescription medications can only be administered by a leader if written permission has been and that all medications will be kept in their original packaging showing clearly the pharmacy label containing all required information.
6. I declare that the information provided in this application is complete and correct and is based on advice provided by a medical practitioner.
7. I agree to pay the full fees by the closing date of 1st November 2024 (or 18th October for earlybird pricing to apply).
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 Name
Signed by Relationship
Should be Empty:

State Junior's Camp 2024 Registration

Leader Registration

Working with Children Blue Card

Parent/Caregiver Details

Medical Details

Medication

Other Details

Emergency Contact Person

Payment Details

Agreement and Consent

Participant Agreement (over 18 years)

Parent/Caregiver Agreement