AMBITIOUS U :: UNLEASHING THE GIANT WITHIN
Registration: AMBITIOUS U - Tue 11th & Wed 12th April 2017
Student Details
Student's Full Name *
Your answer
Student's Address *
Street, Suburb, State, Postcode
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Student's Telephone Number *
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Student's Email Address *
Your answer
Student's Gender *
Special Dietary Needs
Please list any essential dietary requirements
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Medical Details
Please advise of any essential medical information we need to know.
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Emergency Contact Full Name *
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Emergency Contact Address *
Street, Suburb, State, Postcode
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School Details
School/College *
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School Address
Street, Suburb, State, Postcode
Your answer
Year Level *
Pastoral Care / Form Teacher *
Name and relationship to student
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Pastoral Care / Form Teacher Email Address *
Your answer
Consent
Informed Consent and Acknowledgement *
I hereby give my approval for my child’s participation in any and all activities prepared by Ambitious U on 11th & 12th April 2017.
Permission to be Photographed or Filmed *
I give my permission for my child to be photographed or video recorded. I understand that the image may be displayed in publications or websites. I understand that as a precaution my child’s name will NOT be published or linked with photographs.
Emergency Authorisation *
I authorise the leader/s in charge of the Ambitious U Forum where it is impractical to communicate with me, to arrange for my child to receive such medical treatment as the leader/s may deem necessary at any time during the activities of Ambitious U. I further authorise the use of an Ambulance if necessary. I accept responsibility for payment of all expenses associated with such treatment. I appreciate that every care will be taken by the leaders and those connected with Ambitious U cannot be held responsible for personal injury, loss or theft of property affecting my child.
Parent / Guardian Name *
Your answer
Parent / Guardian Mobile Number *
Your answer
Parent / Guardian Email Address *
Your answer
Terms and Conditions *
As a parent / Guardian I have read and understood all the terms and conditions of the above event including the PPA cancellation policy located on the PPA website : http://peerpower.com.au/events-cancellation-policy-2/
Event Details
Payment Details:
Total investment $440 per person (Inc. GST)
Upon receipt of your registration form an invoice will be sent to you to assist with facilitating full payment to secure registration at the event (7 day terms apply). NB: E.F.T. only (no credit card facility available).

Dress Code:
PLEASE NOTE: Smart casual active wear – e.g., jeans, sandshoes (not open shoes or sandals, thongs), collared polo shirts (no inappropriate images or branding permitted)

Venue:
St Margaret’s Independent Learning Centre, St Margaret’s AGS, 11 Petrie St, Ascot.

For further details contact Krys on (07) 3311 2915, (Emergency contact 0466 473 490) or krys@peerpower.com.au

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