EQUIP NSW/ACT Registrations
1 - 7 October 2017

Registration Cost   :   $375.00

Collaroy Centre
22 Homstead Ave
Collaroy NSW 2097

For any queries please email nswactyouthandkids@aue.salvationarmy.org
REGISTER
 
Attendee Type? *

Youth: Under 18yrs, form MUST be completed by Parent/Guardian
Young Adult: 18-25yrs
Staff: Salvos Youth + Kids Member, Elective + REPS Staff

*Please fill out 1 form per attendee. If you are a parent registering 3 children please click on button (D) for the third child you register .

Cost is $375 per person if paying by corps. If paying by credit card your total will be $381.86 (which includes a processing fee). Payment options are at the end of this form.

 
As you have 3 children attending EQUIP you do not have to pay for your third child. Please select the payment option "payment by corps" at the end of this form.

 
What is your favourite snack? *

 
What is your favourite drink? *

 
Please confirm the stream/responsibility you have been given *

Select the stream/responsibility you have been asked to lead at EQUIP NSW/ACT 2017:

 
Are you interested in participating in Free Time Supervision, Rec. Support Team or helping in the milk bottle crew? *

Please select all that apply.
Free Time Supervision -  supervise the free time chill space & campers heading down to the shops. (You will be unable to take any under 18's off site unless selected.)
Rec. Support Team - oversee & assist in various elements of each rec. (social) event at camp.
Milk Bottle Crew - assist with night duty for under 15's.
(doing the daily wrap up & prayer in cabins, settling campers for bed, supervise until sleeping)

By selecting A, B, or C, you will be placed on a roster in a supporting leadership role for those responsibilities. Your commitment would not be every day, unless you communicate via email that you are happy to do so.

 
Do you hold a current Working with Children or a Vulnerable Person Check.
*


 
Please enter your Working with Children Check details here:

 
Name on Working with Children Check? *

 
Working with Children Check Number? *

 
Expiry date of Working with Children Check. *

 
Please enter your Working with Vulnerable People Check details here:

 
Name on Working with Vulnerable People Check? *

 
Working with Vulnerable People Check Number? *

 
Expiry date of Working with Vulnerable People Check. *

 
Have you completed a Safe Salvos course in the last 3 years? *


 
Please list course info (where completed & year completed) *

 
Have you completed an 'Application for Ministry' & 'Code of Conduct' form at your corps? *


 
About the attendee (i.e. you or your child)

These questions refer to the individual who will be attending EQUIP.
 
What is your first name? *

Please enter your first name as per your identification.
 
What is your last name? *

Please enter your last name as per your identification.
 
Do you have a preferred/nick name? *

Please include only if different from your identifcation. If not applicable please enter N/A.
 
Gender? *


 
Date of Birth? *

 
What year is {{answer_PlNB}} in? *

If you have left school please select the year you would be in.

 
Please list the names of any friends that you would like to share a cabin with? *

Please note that you can only share cabins with people in similar age groups to you e.g. 12-14, 15-17, 18+

If not applicable please enter N/A
 
What is your/your child's first preference for Stream 1? *


 
What is your/your child's second preference for Stream 1? *

The first preference you picked for Stream 1 cannot be made for your second preference for Stream 1, so you cannot select: {{answer_51747893}} again.

 
What is your/your child's first preference for Stream 2? *


 
What is your/your child's second preference for Stream 2? *

The first preference you picked for Stream 2 cannot be made for your second preference for Stream 2. So you cannot pick {{answer_51748279}} again.

 
Attendee Contact Info - details of the person attending.

 
Please list what other corps you attend: *

If not applicable please enter n/a
 
What is the mobile number of the person attending?
*

Please enter n/a if not applicable (i.e. if your child does not have a mobile)
 
What is your/your child's street address? *

Please include number & name of street only in this field.
 
What is your/your child's suburb? *

 
What is your/your child's postcode? *

 
What is your/your child's t-shirt size? *

Remember this refers to the person who is attending Equip!

 
What is your/your child's swimming ability? *

Don't forget to bring swimmers and towel.

 
Emergency Contact & Medical Information *

By clicking on 'I accept' you agree that in the event of an emergency where your/ your child's nominated emergency contacts aren't unavailable:

You authorise the leaders to obtain medical advice and/or assistance which they deem necessary.

You further authorise qualified practitioners to administer anesthetic, if required.

You accept all operation, blood transfusion and/or anesthetic risks involved in the event that such procedures are deemed necessary.

You accept the responsibility for payment and agree to pay medical, transportation and any other related expenses.
     
 
Emergency Contact #1 for you/your child*

*Please list the name & contact details of someone we can contact in an emergency for the attendee. For persons under 18yrs this is required to be a parent or guardian.
 
Name of Emergency Contact #1 *

 
What is {{answer_gFq4}}'s relationship to you/your child? *

 
What is {{answer_gFq4}}'s Contact Number? *

 
Emergency Contact #2 for you/your child

*Please list the name & contact details of someone we can contact in an emergency for the attendee.
 
Name of Emergency Contact #2 *

 
What is {{answer_sixW}}'s relationship to you/your child? *

 
What is {{answer_sixW}}'s Contact Number? *

 
Medicare Card Details for you/your child.

 
Medicare Card Number. *

 
Number on Card. *

 
Valid to? (MM/YYYY). *

 
Do you/your child  have a government Healthcare Card? *

     
 
What is the CRN Number? *

 
What is the CRN Expiry Date?
(mm/yyyy) *

 
Are you/your child a Member of a Private Health Fund? *


 
What is the name of your/your child's private health fund? *

 
What is your Private Healthcare Number? *

 
What type of cover do you have? *


 
Do you/your child have a pre-existing or present medical condition? *

     
 
Please list the medical condition and specify details. *

 
Do you/your child have a second pre-existing or present medical condition? *

     
 
Please list the medical condition and specify details. *

 
Do you/your child take any medication?

(whether or not you/your child has a medical condition) *

     
 
Medication Information.

 
What is the name of the medication? *

 
What is the {{answer_QYr7}} prescribed for? *

 
What is the dosage of the {{answer_QYr7}} ? *

Please include amount, time & frequency
 
Any special instructions for administering the {{answer_QYr7}}? *

 
What are the storage instructions for {{answer_QYr7}}? *

 
Do you give permission for your child to self-administer the medication? *


 
Is there another medication you or your child takes? *

     
 
Medication Information

 
What is the name of medication #2? *

 
What is the {{answer_QYr7}} prescribed for? *

 
What is the dosage of the {{answer_QYr7}} ? *

Please include amount, time & frequency.
 
Any special instructions for administering the {{answer_QYr7}}? *

 
What are the storage instructions for {{answer_QYr7}}? *

 
Do you give permission for your child to self-administer their medication? *


 
Is there another medication you or your child takes? *

     
 
Medication Information

 
What is the name of medication #3? *

 
What is the {{answer_tYiB}} prescribed for? *

 
What is the dosage of the {{answer_tYiB}} ? *

Please include amount, time & frequency
 
Any special instructions for administering the {{answer_tYiB}}? *

 
What are the storage instructions for the {{answer_tYiB}} ? *

 
Do you give permission for your child to self-administer their medication? *


 
What is your/your child's food allergy? *

 
Please advise of what the other dietary requirement is by emailing
nswactyouthandkids@aue.salvationarmy.org.

 
Camper Behavioural Agreement
If you are filling this out for your child please accept on their behalf *

By attending Equip NSW/ACT I agree to:
1. Be where I should be:
> Attend and participate in all scheduled events
> Stay within event boundaries
> Remain on-site for the duration of all scheduled activities.
> Only leave site with appropriate permission and follow sign in/out procedures.
> For Under 18's: be in my room by 10.30pm with lights out by 11.00pm and stay in my cabin. Over 18's: be respectful of others when entering the cabin.
> Stay away from showers, toilets and rooms of the opposite gender.
> Sleep in my own bed - one person per bed.

2. Treat others, and their property, with respect:
> No putting others down; no foul, abusive, racist, sexist language or humour
> Do not touch property that does not belong to me.
> Do not interfere with equipment or facilities.
> Do not engage in violent or threatening behaviour.
> Do not use social media or electronic devices to bully or harass others, or to post/send inappropriate text messages, comments, information, photos, hashtags etc.
>Dress modestly and in good taste - clothing with offensive language or themes, or does not appropriately cover the body, is unacceptable and you will be asked to change your outfit.

3. Follow ALL leaders instructions.

4. Wear my lanyard for the duration of the event.

5. Equip NSW/ACT is a drug, alcohol, and smoke-free event. Do not bring any drugs or drug paraphernalia, alcohol or cigarettes (including e-cigarettes) - any of these items in your possession will be confiscated and appropriate disciplinary action will be taken.

6. If you bring your own car, you must park it in an approved location during scheduled activities and not use it to transport others without permission from camp organisers.

7. I understand that if I fail to fulfil any of these requirements I will be asked to leave. Any costs associated with my departure will be my responsibility or that of my parent/caregiver/guardian.

I also understand that continued attendance at this event requires:
- A willingness to participate in all camp activities.
- Remaining on-site during all scheduled activities and following sign in/out procedures when leaving site.
- Adherence to the Camper Behavioural Agreement. 

     
 
Permission/Indemnity for myself/my child

Please read the following questions and select your response for each question.
 
Who are you filling out the permission/indemnity for? *

For those under 18yrs, this MUST be completed by Parent/Guardian.

 
I consent to my child becoming a member of and taking part in the overall activities of Equip NSW/ACT. *

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

     
 
I give permission for my child to attend optional off-site activities during free time under the supervision of approved young adult leaders as arranged by the above-mentioned event. *

     
 
I give permission for my child to be given Paracetamol by a person qualified to administer First Aid in the event that they require it. *

     
 
I give permission for my child to be given Ibuprofen by a person qualified to administer First Aid in the event that they require it. *

     
 
I give permission for my child to be transported in corps vehicles or private cars arranged by the leaders of the above-mentioned event on those occasions when it is necessary, including offsite activities. *

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

     
 
I give permission for my child to be photographed and/or videotaped. I understand that the image/video may be displayed in Salvation Army publications or websites. I understand that my child's name MIGHT be published or linked with photographs. *

     
 
Permission/Indemnity

Please read the following questions and select your response for each question.
 
I consent to becoming a member of and taking part in the overall activities of Equip NSW/ACT. *

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

     
 
I am happy to be transported in corps vehicles or private cars arranged by the leaders of the above-mentioned event on those occasions when it is necessary. *

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

     
 
I consent to be photographed and/or videotaped. I understand that the image may be displayed in Salvation Army publications or websites. I understand that my name MIGHT be published or linked with photographs. *

     
 
I confirm that the information contained on this form is true and correct. *

     
 
I agree to inform the event organisers via email/in writing of any changes to these details by emailing nswactyouthandkids@aue.salvationarmy.org. *

     
 
I understand that all reasonable safety precautions will be taken at all times by the above-mentioned group and the event organisers and those connected with the group cannot be held responsible for personal injury, loss and/or damage incurred by the subject of this form. *

     
 
I understand that The Salvation Army is part of the Christian church and as such will run this event acting on those principles and beliefs associated with the Christian faith. *

     
 
Please read our below Privacy Policy. By clicking 'I accept' you agree to the conditions of our Privacy Policy.
If you are a parent/guardian completing this form on behalf of your child you are accepting this policy on your child's behalf. *

 
How are you making payment? *


 
Payment through corps.

Your total comes to:  {{var_price}} *

If you have selected this option all your camp fees are payable to your corps. By clicking 'I accept' you agree to speak to your corps officer about payment.
     
 
Credit Card Payment *

Please note in addition to the below charge you will be charged a 1.75% + $0.30c processing fee making your final total $381.86
 
Please enter your Credit or Debit Card number: *

 
The CVC number: *

(3 or 4 digit security number on the back of your card)
 
The name on your card: *

 
Your card's expiry month: *


 
Your card's expiry year: *


Thanks for registering - Join our EQUIP NSW/ACT Facebook group for ongoing information & camp updates
EQUIP Facebook Group
You are unable to attend this event as a leader without a current Working with Children's Check.

Please contact your corps officer to find out how you can obtain one.
You are unable to attend this event without completing an Application for Ministry and Code of Conduct.

Please contact your officer to find out how you can apply for one.
You are unable to attend this event without completing safe salvos training.

Please speak to your corps officers to find out how you can apply for the next Safe Salvos workshop.