Xplore23 Registration

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𝟲𝗽𝗺 𝗙𝗿𝗶𝗱𝗮𝘆 𝟭𝟲 𝗝𝘂𝗻𝗲 – 𝟮𝗽𝗺 𝗦𝘂𝗻𝗱𝗮𝘆 𝟭𝟴 𝗝𝘂𝗻𝗲 𝟮𝟬𝟮𝟯
At Community Church Campground, Youth Camp, Coomalie Creek NT 0822

𝗙𝗼𝗿 𝘆𝗼𝘂𝗻𝗴 𝗮𝗱𝘂𝗹𝘁𝘀 𝗳𝗿𝗼𝗺 𝗬𝗲𝗮𝗿 𝟭𝟭 𝘁𝗼 𝟮𝟱 𝘆𝗲𝗮𝗿𝘀 𝗼𝗹𝗱
(Contact us if you are outside this range and would like to attend)

𝗖𝗼𝗺𝗲 𝗮𝗻𝗱 𝗘𝗫𝗣𝗟𝗢𝗥𝗘:
- God's mission in the world
- Your place in God's mission
- Bushcraft & survival skills

I am a: *

Young adult

Leader

Name *

Church I attend *

Birthday *

YYYY

Gender *

Email *

Phone *

Parent/guardian email (optional if over 18)

Parent/guardian phone (optional if over 18)

Medicare card number (11 digits, including your Individual Reference Number) *

Emergency contact name(s) & relationship *

Emergency contact phone number(s) *

In the case of an emergency, if we are not able to contact your emergency contact, do you give the leaders permission to seek appropriate medical assistance? *

Yes

Do you have ambulance cover (either private insurance or by having a Health Care Card)? *

Yes

Do any of the following apply to you? Or is there any reason your participation in camp may be limited?

ADD/ADHD

Allergies

Asthma

Dizziness/fainting

Epilepsy or fits/convulsions

Learning disability

Medication required on camp

Physical disability

Recent illness

Other:

Please provide details for the above

Do you have any dietary requirements? (Please provide details of severity)

Photos *

I have a legal reason why my photo cannot be used for promotional purposes

I give permission for photos taken on camp to be used for promotional purposes

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