Young Adults Winter Retreat 2022

Date: Friday 8th - Sunday 10th July

Location: 3-5 Broughton Avenue, Cowes, Philip Island

Cost: $110

We will depart from GWAC at 12pm on Friday and depart Philip Island 12pm on Sunday. Other departure times by arrangement.

Contact Brad Jackson for more information

b.jackson@gwac.org.au

0404 492 171

Name *

Date of Birth *

Phone number *

Attendance

Full time

Part time

If part time, indicate when:

I have a car, and I'm willing to drive

yes

Comments

Medical information

Medicare number

IRN

Health/Ambulance Fund Name

Health/Ambulance Number

Special Dietary Requirements

Allergy Information

Will the participant be bringing any medication on retreat?

Please provide relevant details regarding dosage

Who will administer the medication?

Do you OBJECT to Panadol being given for minor pains and headaches?

Is there any other information about the participant that should be known?

Parent or Guardian Details

Name

Mobile Number

Relationship to Participant

Parent or Guardian Details 2

Name

Mobile Number

Relationship to Participant

Permissions

By signing this form, via the check box below, I acknowledge that:

I, being the parent/guardian of the participant/s whose correct details appear in the "submission data" above, give the permission for my youth to attend the Young Adults Winter Retreat 2022 from Friday 8th July - Sunday 10th July 2022 and fully participate in all activities associated with the retreat.

Medical Consent:
I authories the leader(s) in charge of the Glen Waverley Young Adults Ministry, to consent on my behalf, where it is impractical to communicate with me, to medical and/or surgical treatment, including ambulance transport as may be deemed necessary. I understand that I am responsible for the cost of all such treatment or transport for the above named participant/s.

Media Release and Authorisation:

I understand that there may be photographs and/or video footage taken of my child during ministry activities and understand that no royalty, fee or other compensation shall become payable to me by reason of any use.

I am willing for my child to be so filmed in appropriate settings. My child is also willing for photographs and/or video footage to be taken of them.

I am willing for these photos or footage to be used to PROMOTE MINISTRY WITHIN GWAC in a way that does not identify their name or details. This includes photos/videos shown at any GWAC Gathered Services.

I am willing for these photos or footage to be used to PROMOTE MINISTRY EXTERNAL FROM GWAC in a way that does not identify their name or details. This includes printed publications, the GWAC website and GWAC social media outlets.

If there are specific information about taking photographs or using video footage that would help the GWAC ministry team

Confirmation:

To fully complete registration, payment for retreat must also be made. This can be done by bank transfer. The cost of camp is $110.

For the reference, please put the last name of the participant and word "retreat".
(eg. for Brad Jackson it would be Jackson retreat)

St Barnabas Glen Waverley Anglican Church

BSB 033 009

Account Number 108940

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Name on Signature:

Date of Signature.