Friday 11 - Sunday 13 August 2017
Alexandra Park
13 Mari St
ALEXANDRA HEADLAND QLD 4572

$99 for Saturday Only
$119 for Saturday & Sunday without accommodation
$179 full delegate in a shared cabin
$199 full delegate in a shared cabin with ensuite
*overnight guests must bring their own linen* 
(incl. bed sheets, blankets, pillows, and towels)

*REGISTRATIONS CLOSE FRIDAY 4 AUGUST*
If you have any questions about this event please email just.men@aue.salvationarmy.org
CLICK HERE TO REGISTER
 
What is your first name? *

 
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What is your D.O.B? *

 
What corps/centre do you attend?

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What is your mobile number? *

 
What is your street address? *

Please only include the number and street name here
 
What is your suburb? *

 
What is your state? *

 
What is your postcode? *

 
Please include the full name of someone we can contact in case of an emergency *

 
What is {{answer_BkNj}}'s relation to you? *

 
What is {{answer_BkNj}}'s  contact number? *

 
Do you have any medical conditions or allergies? *

If yes, please include the name of condition/s or allergies, medication details, and an action plan.

Please enter n/a if not applicable.
 
Are you currently using prescribed or any drugs of dependence? If so please provide details: *

please enter n/a if not applicable
 
What is your name as shown on your Medicare card? *

 
What is your medicare card number? *

 
What is the expiry date of your medicare card? *

(mm/yyyy)
 
Do you have private health insurance? *

     
 
What is the name of your private health insurer? *

 
What is your private health insurance member number? *

 
Do you have any dietary requirements? *

If yes, please include relevant details.

Please enter n/a if not applicable.
 
Please select the relevant delegate type *

Saturday Day Delegate ($99) - includes Morning Tea, Lunch, Afternoon Tea, Dinner and Supper.
Saturday & Sunday Day Delegate ($119) - Saturday includes: Morning Tea, Lunch, Afternoon Tea, Dinner & Supper.
Sunday includes: Morning Tea & Lunch.
Full Delegate in Cabin ($179) - includes all meals and accommodation.
Full Delegate in Cabin with ensuite ($199) - includes all meals and accommodation.

*Overnight guests must bring all linen with them*

 
Please confirm when will you be checking into Alexandra Park? *


 
Please confirm when will you be checking out of Alexandra Park? *


 
Is there anyone you'd like to share a room with? if so please specify who: *

Please enter n/a if not applicable.
 
Do you have any specific room requests? If so please specify: *

please enter n/a if not applicable
 
Please review our Privacy Policy.

By clicking 'I accept' you agree to the conditions as outlined in this policy. *

Please click on the below link to review our privacy policy: 

https://salvos.org.au/about-us/governance-and-policy/privacy-policy/
     
 
Permission/Indemnity

Please read the following points and select your response for each:
 
I understand that all reasonable safety precautions will be taken at all times by The Salvation Army and its leaders, and I agree that those in The Salvation Army connected with organising and operating the Just Men conference cannot be held responsible for personal injury, loss or damage incurred by the submission of this form and attending the Just Men conference. *

     
 
I understand that, if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that I cannot be contacted in an emergency, I give permission to receive such medical treatment as the leader may deem necessary. *

     
 
Where required I am willing to be transported in Salvation Army vehicles or private cars arranged by the leaders of the Just Men conference travelling to, from and during camp. *

     
 
I consent to information about myself being collected as required for activity specific permission forms and accident/incident report forms. *

     
 
I am willing to be photographed or videoed for the purposes of keepsakes or promotional material for the purposes of the event and The Salvation Army generally. *

     
 
Liability Waiver, and Terms and Conditions *

It is important that you read and accept the following Liability Waiver, and Terms and Conditions. If you do not do so, you will not be allowed to register for and participate at the Just Men Conference.

1) For the purpose of this Registration Form, The Salvation Army means:   
a)    The Salvation Army (being the unincorporated religious and charitable association);
b)    The Salvation Army (New South Wales) Property Trust;
c)    The Salvation Army (Queensland) Property Trust;
d)     Any organization or bodies corporate owned or operated by any of the bodies in the paragraphs mentioned above; and
e)     Any employee, officer, servant, contractor or agent of a body described in the paragraphs mentioned above.  

2) I am aware of and I accept the risks associated with my attendance and participation at the Just Men conference, which includes but is not limited to personal injury, damage or loss of property, or death. I understand there are acts and circumstances beyond the control of The Salvation Army. As such, I release and discharge The Salvation Army from any and all claims of loss, damage, or harm to property or persons including but not limited to myself/my child, made by me or any other persons as a result of my/my child’s attendance and/or participation at the Just Men conference, and I agree this release and discharge is in respect of any negligent act, breach of duty, default and/or omission by The Salvation Army.  

3) I agree to indemnify The Salvation Army against any and all claims made by me or any other persons for loss, damage, or harm to property or persons including but not limited to myself/my child, as a result of my attendance and/or participation in the Just Men conference. This indemnity operates to cover any negligent act, breach of duty, default, breach of contract and/or omission by The Salvation Army.  

4) I accept that I will be given the opportunity to undertake recreational activities during my attendance at the Just Men conference. I recognise that I am undertaking these recreational activities for the purposes of enjoyment, relaxation, and leisure. I accept there is a degree of physical and psychological risk to these recreational activities and in making the decision to undertake the following activities, I understand and I am aware of the risks arising from these recreational activities including but not limited to the following:
a) General Activities: illness, physical injuries, harm arising from any transportation accidents, fall injuries, injury from equipment failure, allergic reaction;
b) Sports Activities: sunburn, cuts, bruising, fall injuries, sprains, fractures, asthma related harm, collision injuries, head injuries including concussion;
c) Archery: Bodily harm from misuse of equipment, injury from equipment failure, puncture wounds, splinters, fall injuries, bruising;
d) Billy Cart Racing: cuts, bruises, collision/crash injuries, emotional distress, trips or falls, sprains, fractures, spine and back injuries, internal injuries, head injuries including concussion, injury from equipment failure, paralysis, death;
e) Touch Football: asthma related harm, trips or falls, collision injuries, sprains, fractures, head injuries including concussion; and
f) Golf: Bruising, sprains, fractures, spine and back injuries, trips and falls.  

5) I agree to assume the risk of any injuries, damages or loss that I/my child may sustain as a result of being a participant or observer in the activities connected or associated with the Just Men conference. I declare that I have read and understood the risk warning above.  

6) I understand that my participation in the listed recreational activities and any other activities that take place is entirely voluntary and if I do not/my child does not wish to participate in any or all of the aforementioned recreational activities, I shall give express prior notification to The Salvation Army.  

7) I warrant that I do not have any medical, physical or psychological conditions that would prevent or aggravate my attendance and/or participation at the Just Men conference, including for the listed recreational activities. I understand that if I cannot provide this assurance, I will give prior notice of my medical conditions to The Salvation Army.  Following this notification, I accept that The Salvation Army will have sole discretion to allow, decline or limit my participation in the Just Men conference.   

8) I authorise The Salvation Army to obtain such medical assistance and treatment for me as they deem necessary and I agree to meet all of these medical expenses.
 
9) I understand that The Salvation Army has a responsibility to maintain a safe and positive environment for both participants and staff members at the Just Men conference. I recognise that I am expected to show respect for fellow participants and staff members. I also understand that the Just Men conference and the premises at Alexandra Park is an alcohol and drug free environment. I declare I will not be in possession of or consume any forms of alcohol or drugs during my attendance and participation at the Just Men conference, on the Alexandra Park's premises or at any of its associated activities. I accept that The Salvation Army reserves the right to conduct alcohol or drug testing at any time and without prior notice, to determine my compliance under these Terms and Conditions and I accept that I will be required to comply with directions given by The Salvation Army to facilitate this testing process.  

10) In response to misconduct or non-compliance, I understand that The Salvation Army reserves the right to exercise any of the following measures against me/my child, including but is not limited to close supervision, directions, exclusion from the Just Men conference and/or police involvement. I accept that The Salvation Army will not refund any part of the payment for the Just Men conference if I am removed or excluded as a result of my misconduct or non-compliance with these Terms and Conditions.
 
11) In addition to paragraph 10, I agree that I am to be bound by and I declare I will comply with all of the rules and guidelines issued by The Salvation Army in connection with the Just Men conference and the premises at Alexandra Park. I understand that I need to read and understand all of the rules and guidelines made available to me by The Salvation Army. I accept that non-compliance with these rules and guidelines will be dealt with by The Salvation Army within its sole discretion and according to the following measures, including but not limited to close supervision, directions, exclusion from the Just Men conference and/or police involvement.  

12)  I accept that transportation will be arranged by The Salvation Army for me to attend activities outside of Alexandra Park. I agree that I am to be transported according to this manner and I release The Salvation Army from any claim made by me as a result of loss, damage or harm to me arising from this manner of transportation.  

13)  I understand that The Salvation Army is an Evangelical Christian Church and as such, its premises and activities will have involvement and adherence to these Evangelical Christian principles.   I declare that I have read and that I accept the Liability Waiver, and the Terms and Conditions provided above.
     
 
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As you are paying through your corps please ensure you make payment directly to your corps officer before the event.

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Thanks {{answer_wSXe}} for registering for the Just Men QLD Conference.

Friday 11 - Sunday 13 August 2017
Alexandra Park
13 Mari St
ALEXANDRA HEADLAND QLD 4572

A confirmation will now be sent to your e-mail.

For any queries about this event please e-mail
just.men@aue.salvationarmy.org
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