Training Registration – Scripture Union

Training Type*
LEAD Winter
Dates: Tuesday July 21st – Friday July 24th 2020
Location: Camp Geo, Busselton
Cost: $120
Transport: Options for transport may be offered by SU at $5 cost each way - campers will be updated with options over the coming weeks.
Are you over 18?*
- I am over 18
- I am under 18
If not, we'll need to get a parent/guardian to sign the SU WA agreement
Contact or Pastor at my Church*
Name Mobile No. Email address
I'd like a LEAD Winter Team Leader to contact this person about:*
- Praying for me while I'm on camp
- Asking if my church can sponsor all or part of my camp fees
- Both of the above
- None of the above
Just Community
Product Name*
Total number of family members to be registered?
Price: $ 5.00 Quantity:
Participant Details*
Press the '+' symbol on the right side to create a new row for each family member.
First Name Last Name Gender Phone Email
Any dietary requirements we should be aware of?
MAD (Make A Difference) Student Workshop
Product Name*
Total number of siblings to be registered?
Price: $ 20.00 Quantity:
Participant Details*
Press the '+' symbol on the right side to create a new row for each sibling
First Name Last Name Gender Phone Email
Any dietary requirements we should be aware of?
SU WA Orientation
Choose Your Orientation Date*
Shirt Size
All new SU WA Volunteers get a free shirt!
Orientation Status*
Which SU program are you planning to attend?*
Any allergies?
Dietary or other
Severity and treatment of allergy if you do have one
E.g. anaphylaxis, carry epi pen in bag at all times
DON'T PANIC! Small Group Facilitation Training
Session dates TBC. Register your interest and we'll contact you when a session is scheduled.
Any dietary requirements we should be aware of?
Taco Tuesday
Camp Volunteer Information Night
When: Tuesday 5th June @ 6:30pm
Where: SU WA Office - 7 Irvine St Bayswater
Any Dietary Requirements?
BOOST
Which Boost Year would you like to register for?*
Boost Year 1 Sessions*
- First session: 'Commit' - Saturday 22nd Feb
- All sessions
Would you like to register ADDITIONAL siblings?
Leave blank if you are registering for only one person
Price: $ 25.00 Quantity:
Would you like to register ADDITIONAL siblings?
Leave blank if you are registering for only one person
Price: $ 60.00 Quantity:
Make sure you create a new row in the question below for each additional sibling and list their names
Participant Details - please include all participants' names*
Press the '+' symbol to create a new row for each participant
First Name Last Name Gender Phone Email DOB
Parent/Guardian Email Address*
Any dietary requirements we should be aware of?
Bronze Medallion
Are you an SU Member? (volunteer or pledged supporter)
- Yes
- No
Which course are you applying for?*
Which course are you applying for?*
Summer Missions Celebration Day
Come and share a BBQ dinner and hear about all that God has been doing through SU Summer Missions this year.
Names of attendees*
First Name Last Name
Phone number
Email address
Name of Summer Mission Attended*
- Augusta - Flinders
- Augusta - Turner
- Bremer Bay
- Brookton
- Cervantes
- Cheynes Beach
- Denmark
- Jurien Bay
Any dietary requirements we should be aware of?
Summer Missions Training Day
Date: Saturday 16th November 2019
Where: Como Baptist Church, Cassey Street, Como
Speaker: Ben Smart
Cost: $15 per person
Additional info: Creche will be provided for primary and younger aged children
RSVP: By Monday 11th November
Please note that the Orientation session is now full and won't be accepting further registrations
How many people are you registering for?*
Price: $ 15.00 Quantity:
Which Summer Mission are you planning to volunteer on?*
Names of attendees*
Please use the '+' symbol to add more rows.
Please note that the Orientation session is now full and won't be accepting further registrations
First Name Last Name
Email*
Any dietary requirements we should be aware of?
Contact Information
Name*
First Last
Gender*
Phone*
Email*
Safety & Care
Date of Birth*

DD
MM
YYYY
Emergency Contact 1*
Name Relationship Contact Number
Emergency Contact 2*
Name Relationship Contact Number
Do you consent to appropriate use by SU WA of photographs taken on the program that include you?*
Address*
Address Suburb State Postcode
Medical Information
Insurance Information (if applicable)
Provider Membership Number
Medicare Details*
Card Number Expiry Reference Number
Do you have ambulance cover?*
Do you have any of the following?
Please tick all the apply and provide further information in the box below
- Allergies
- Asthma
- Dietary Requirements
- Fainting/dizziness
- Medication
- Recent broken bones
- Other
Please provide details (including severity & medications)
Covid-19 Declaration
I declare that if I am unwell up to 2 weeks before camp, I will withdraw from camp with written notice to Scripture Union. Upon withdrawal for this reason, I will receive a full refund. I understand that if I do not notify Scripture Union before camp starts, no refund will be given.

I understand that there will be a Scripture Union COVIDSAFE plan in place for this camp, which I must agree to. I acknowledge that a form will be emailed to me, which I must sign and bring with me when I come to camp. I am aware that I will be temperature checked and will need to answer four health questions on arrival in order to be admitted to camp: 1. Are you unwell? 2. Has anyone in your family been unwell in the last 2 weeks? 3. Are you waiting on the results of a COVID-19 test? 4. Have you had contact with anyone who is confirmed to have COVID-19? If I answer yes to any of these questions, I will not be permitted to come to camp.

I acknowledge that in the event that I show two of the four COVID-19 symptoms (fever, cough, shortness of breath, sore throat), I will be tested for COVID-19 at the closest clinic and isolated until a result is available. If I am found to be positive for COVID-19, I understand that I will need to leave camp and am responsible getting myself home.

In the event that there are changes in restrictions, we reserve the right to cancel our camps, in which case you will receive a full refund and the option to transfer to other programs.
Participant Signature*
- I have read and agree to the COVID-19 Declaration.
Agreement with SU WA
I am aware in signing this document for my participation in this program that certain elements of the program could be physically and emotionally demanding. Furthermore, I understand that certain inherent risks and dangers exist in the activities in which I will be participating. I acknowledge that while Scripture Union and its leaders will make every reasonable effort minimise exposure to known risks, all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of Scripture Union, its leaders and staff. In the event of any emergency where my nominated contact people are unavailable:
- I authorise the leaders to obtain medical advice and/or assistance which they deem necessary.
- I further authorise qualified practitioners to administer anaesthetic if required.
- I accept all operation, blood transfusion and/or anaesthetic risks involved in the event that such procedures are deemed necessary.
- I accept the responsibility for payment and agree to pay medical, transport and any other related expenses.
- I confirm that the information contained in this application is true and correct.
- I agree to inform the leader of any change to these details.
- I understand that this training course may be cancelled last minute due to extenuating factors
Participant Signature*
- I agree with the terms and conditions
Agreement with SU WA
Agreement with SU WA I am aware in signing this document for my child's participation in this program that certain elements of the program could be physically and emotionally demanding. Furthermore, I understand that certain inherent risks and dangers may exist in the activities in which my child will be participating. I acknowledge that while Scripture Union and its leaders will make every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of Scripture Union, its leaders and staff. In the event of an emergency where my nominated contact people are unavailable: I authorise the leaders to obtain medical advice and/or assistance which they deem necessary. I further authorise qualified practitioners to administer anesthetic if required. I accept all operation, blood transfusion and/or anesthetic risks involved in the event that such procedures are deemed necessary. I accept the responsibility for payment and agree to pay medical, transport, and any other related expenses. I confirm that the information contained in this application is true and correct. I agree to inform the leader of any change to these details I understand that the camp leaders will take all responsible care of my child whilst at camp and that SU WA or its representatives will not be liable in any injury or accident, or for damage or loss of property. I understand that in cases of unacceptable behavior, campers will be sent home from camp.
Parent/Guardian Signature*
- I agree with the terms and conditions
Payment
Camp: Worldview Australia Leadership Camp
Fee: $560 ($100 deposit required)
Total
$ 0.00
Please select your payment method*
- Credit Card
- Bank Transfer
- Other
Once you have submitted your form, please contact the SU WA Office for payment details
Enter your Credit Card details*

MasterCard
Visa
Card Number Expiry CCV Cardholder Name

LEAD Winter

Just Community

MAD (Make A Difference) Student Workshop

SU WA Orientation

DON'T PANIC! Small Group Facilitation Training

Session dates TBC. Register your interest and we'll contact you when a session is scheduled.

Taco Tuesday

BOOST

Bronze Medallion

Summer Missions Celebration Day

Summer Missions Training Day

Contact Information

Safety & Care

Medical Information

Covid-19 Declaration

Agreement with SU WA

Agreement with SU WA

Payment

Camp: Worldview Australia Leadership Camp
Fee: $560 ($100 deposit required)

About Our Organisation

EXTRA LINKS

First Name	Last Name	Gender	Phone	Email

First Name	Last Name	Gender	Phone	Email

First Name	Last Name	Gender	Phone	Email	DOB

First Name	Last Name

LEAD Winter

Just Community

MAD (Make A Difference) Student Workshop

SU WA Orientation

DON'T PANIC! Small Group Facilitation Training

Session dates TBC. Register your interest and we'll contact you when a session is scheduled.

Taco Tuesday

BOOST

Bronze Medallion

Summer Missions Celebration Day

Summer Missions Training Day

Contact Information

Safety & Care

Medical Information

Covid-19 Declaration

Agreement with SU WA

Agreement with SU WA

Payment

Camp: Worldview Australia Leadership Camp Fee: $560 ($100 deposit required)

Camp: Worldview Australia Leadership Camp
Fee: $560 ($100 deposit required)