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God is with us!
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From the director
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LEAD Summer and Junior LEAD camps
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About
About Us
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Youth Ministry Support
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Mission Opportunities
Camping
Holiday Camps
Leavers
Young Adults
School Camps
Breakaway
Pay Your Fee
Mission
Online Programs
Holiday Missions
Local Community
Light Party
Pay Your Fee
Schools
Reel Change
Mentoring
SUPA Clubs
School Camps
CHIC & Blokes
Christian Schools
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Junior LEAD Leadership Huddle
Hidden
Program
*
Online
In Person
Junior LEAD Leadership Huddle
This group is specifically for Junior LEAD campers.
This form collects information to ensure that we can support you well.
Hidden
Participant's Name
*
First
Last
Preferred Name (if different)
Date of Birth
*
Day
Month
Year
Gender
*
Please choose
Female
Male
Postal Address
*
Street Address
Suburb
Postcode
Participant's Email
*
Participant's Mobile
*
Participant's School
*
Participant's Church (If Any)
Parent / Guardian Information
Parent or Guardian Name
*
First
Last
Parent / Guardian Relationship
*
Choose A Relationship
Mother
Father
Aunt
Uncle
Grandparent
Caseworker
Carer
Other Guardian
Parent / Guardian Phone
*
Parent / Guardian Email
*
In Person groups
Current Medical Conditions
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ADD/ADHD
Anaphylaxis
Anxiety
Appendicitis
Asthma
Bedwetting
Bronchitis
Chicken Pox
Depression
Diabetes
Ear Infections
Epilepsy/Fits
Fainting/Dizziness
Glandular Fever
Heart Problems
Measles
Migraines
Mumps
Pneumonia
Recent Broken Bones/Illness
Sleepwalking
Tonsillitis
Travel Sickness
Other
Current Medical Conditions - Other
*
Food Allergies/Special Dietary Requirements
*
Does your child have any food allergies or special dietary requirements that SU should be aware of?
No
Yes
Please provide details of food allergies/special dietary requirements
*
Additional Participant Information
*
Are there any family, behavioural, mental health or medical conditions which require special attention we should know about? E.g. hearing or sight or other impairment, ADD or ADHD, court order or custody issues, formal counseling situations, or any other?
Choose an answer
No
Yes
Please Provide Details
*
Emergency Contact Name
*
Must be different to the primary contact provided above
First
Last
Emergency Contact Relationship
*
Choose A Relationship
Mother
Father
Aunt
Uncle
Grandparent
Caseworker
Carer
Family Friend
Sibling
Other Guardian
Emergency Contact Phone
*
Online groups
Online Access
*
This program will run on Zoom, using internet on a device. Please confirm that your child will have access to the following:
- My child has access to reliable internet
- My child will have access to a device
- I am prepared to download the Zoom application onto my child's device
I confirm that my child will have the above-mentioned access
Responsible adult at home
*
I understand that during the program sessions, an adult must be present in the home, and that the adult(s) present in the home are responsible for the health and safety of the child.
The child should be in a common area rather than a bedroom while participating in the group.
I understand and accept these conditions
Name(s) of responsible adult(s) who will be home during program sessions
*
First Name
Last Name
Agreement with SU WA
Parent / Guardian Agreement
*
I understand and accept that physical duty of care for my child remains my responsibility, even during program sessions.
I am aware in signing this document for my child's participation in this program that certain elements of the program could be emotionally demanding.
I understand that the program leaders will interact online with my child during the program and authorise them to use Zoom as the online platform for communication. I understand that SU WA or its representatives will not be liable in any injury or accident, or for damage or loss of property.
I agree with the terms and conditions for sending a participant on a Scripture Union WA program.
Parent / Guardian Agreement
*
The group sessions will be held in a public location. I will drop off and pick up my child as arranged for these sessions.
I am aware in signing this document for my child's participation in this program that certain elements of the program could be emotionally demanding.
I understand that the session leaders will take all responsible care of my child and that SU WA or its representatives will not be liable in any injury or accident, or for damage or loss of property.
I agree with the terms and conditions for sending a participant on a Scripture Union WA program.
Photo Consent
*
Do you consent to appropriate use by SU WA of photographs taken on the program that include your child?
Choose an answer
Yes
No
Child Contact Consent
*
Do you consent to a leader contacting your child to arrange timing of the group session?
Choose an answer
Yes
No
Phone
This field is for validation purposes and should be left unchanged.
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