Welcome to the Songwriters Summit and Worship Night online registration!

Friday 21 - Sunday 23 July 2017
The Collaroy Centre
22 Homestead Ave
Collaroy NSW 2097

*REGISTRAITONS ARE NOW CLOSED - PLEASE EMAIL CAMILLE.KAJDA@AUE.SALVATIONARMY.ORG*

Please arrive for a 7pm start on Friday,  the summit will finish after lunch on Sunday.

$106 per person for the weekend or
$53 per person for day registrations

 
Please enter the details of the person who is attending the Songwriters Summit.

If you are a parent or guardian completing this form on behalf of your child please enter their details.
 
Hi There! What is your first name? *

 
Thanks {{answer_Q4x1}}! And what is your last name? *

 
What is your D.O.B? *

 
What corps/centre do you attend?

 
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_kX0f}}'s relation to you? *

 
What is {{answer_kX0f}}'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.

Leave blank if not applicable.
 
Are you currently using prescribed or any drugs of dependence? If so please provide details:

Leave blank 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 select the relevant delegate type *

Day delegate:  $53 per person (includes morning tea, lunch and afternoon tea on the Saturday)

Weekend delegate: $106 per person (includes accommodation and all meals from Friday supper to Sunday lunch)
*The weekend rate of $106 applies even if you are staying only 1 night.

 
Please confirm when will you be checking into Collaroy?


 
Please confirm when will you be checking out of Collaroy?


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

 
Do you have any specific room requests? If so please specify:

(i.e. a port-a-cot for an infant)
 
Do you require flights to be booked? *

     
 
As you require flights please email: camille.kajda@aue.salvationarmy.org immediately after completing this form to request a flight requisition form.

 
Please review our Privacy Policy.

By clicking 'I accept' you agree to the conditions as outlined in this policy. If you are a parent/guardian completing on behalf of your child you are accepting on your child's behalf. *

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 will attend/I consent to my child attending the Songwriters Summit and taking part in the overall activities. *

     
 
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 Songwriters Summit cannot be held responsible for personal injury, loss or damage incurred by the submission of this form and attending the Summit. *

     
 
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/for my child to receive such medical treatment as the leader may deem necessary. *

     
 
I give permission for a person qualified to administer First Aid to administer Paracetamol to myself/my child. *

     
 
I give permission for a person qualified to administer First Aid to administer Ibuprfoen to myself/my child: *

     
 
I am willing/I give permission for my child to be transported in Salvation Army vehicles or private cars arranged by the leaders of the Songwriters Summit travelling to, from and during camp. *

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

     
 
I am willing/I give permission for myself/my child 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 Songwriters Summit.  

1) For the purpose of this Registration Form, The Salvation Army means:  
a)     The Collaroy Centre;
b)     The Salvation Army (being the unincorporated religious and charitable association);
c)      The Salvation Army (New South Wales) Property Trust;
d)     The Salvation Army (Queensland) Property Trust;
e)     Any organization or bodies corporate owned or operated by any of the bodies in the paragraphs mentioned above; and
f)       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/my child’s attendance and participation at the Songwriters Summit, 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 Songwriters Summit, 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/my child 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 Songwriters Summit and Worship Night. 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/my child will be given the opportunity to undertake recreational activities during my attendance at the Songwriters Summit. I recognise that I am/my child is 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, factures, 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 Songwriters Summit. I declare that I have read and understood the risk warning above.  

6) I understand that my/my child’s 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 either The Salvation Army or The Collaroy Centre.  

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

8) I authorise The Salvation Army to obtain such medical assistance and treatment for me/my child 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 Songwriters Summit. I recognise that I am/my child is expected to show respect for fellow participants and staff members. I also understand that the Songwriters Summit and the premises at The Collaroy Centre is an alcohol and drug free environment. I declare I/my child will not be in possession of or consume any forms of alcohol or drugs during my attendance and participation at the Songwriters Summit, on The Collaroy Centre’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 Songwriters Summit and/or police involvement. I accept that The Salvation Army will not refund any part of the payment for the Songwriters Summit if I am/my child is 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/my child is to be bound by and I declare I will/my child will comply with all of the rules and guidelines issued by The Salvation Army in connection with the Songwriters Summit and the premises at The Collaroy Centre. 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 Songwriters Summit and/or police involvement.  

12)  I accept that transportation will be arranged by The Salvation Army for me/my child to attend activities outside of The Collaroy Centre. I agree that I am/my child is to be transported according to this manner and I release The Salvation Army from any claim made by me/my child, as a result of loss, damage or harm to me/my child 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.
     
 
How are you making payment for the summit? *


 
Please enter the 10 digit GL Code to be charged for your registration:

Your total comes to: {{var_price}}
 
As you are paying through your corps please ensure you make payment directly to your corps officer before the event.

Your total comes to: {{var_price}}
 
Credit Card Payment:

All credit card payments will incur a 1.75% + $0.30c processing fee.
 
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 {{answer_Q4x1}} for registering for the Songwriters Summit!
Friday 21 - Sunday 23 July
Collaroy Centre

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

Please arrive to Collaroy at 7pm on Friday, the summit will finish after lunch on Sunday.

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

We look forward to seeing you there!
Click here to register someone else