YEP Event Registration 2014

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YEP Event Registration 2017
Please select the event you would like to register for: *

Personal Information
Applicant Name *

First Name Last Name
Applicant E-mail *
Applicant Mobile *

Applicant Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Birth Date *

Day Month Year
Age *
Parish *
Are you attending school in 2017 *
Year Level *
School Name *

Emergency Information
Primary Contact (e.g. mother)
Name *
Relationship to applicant *
Home Number
Victorian numbers start with 03
Mobile Number *
Secondary Contact (e.g. father)
Name *
Relationship to applicant *
Home Number
Victorian numbers start with 03
Mobile Number *

Medical Information
Medicare number *
Medicare expiry *
Do you have private medical? *
Private medical fund *
Member number *
Do you have ambulance cover? *
Ambulance member Number *
Regular doctor/clinic *
Phone number *
Year of last tetanus immunisation *
Is normally given at 5 years of age (as Triple Antigen or CDT) and at 15 years of age (as ADT)

Allergies and Dietary
Please tick if you are affected by any of the following:

Penicillin Bee stings Food Other
Please provide allergy details: *
Do you have an EPI Pen? *
Please provide EPI Pen details: *

Legal Consents
1. PHOTO AND VIDEO PERMISSION

The YEP TEAM will take photographs & video of the applicant whilst undertaking YEP activities. These images will be held in accordance with the Jesuit Ministries Privacy Policies and may be used for promotional purposes within the YEP ministries.
Do you give permission for your son/daughter to have the images taken? *
2. SWIMMING PERMISSION

Whilst all care will be taken, YEP TEAM are not trained life guards and as such cannot take responsibility for supervising swimming activities. We will not allow students to swim on beaches that are not patrolled.
Swimming Ability *
Do you give permission for your son/daughter to swim? *
3. MEDICAL ACTION AUTHORITY

I authorise the YEP TEAM to disclose all my medical information to a third party in the event I require medical treatment. I acknowledge that I am responsible for all costs incurred on my behalf for all medical treatment and emergency transport if required. The information on my MEDICAL FORM are an accurate indication of my present medical status. I will advise the YEP TEAM if these details change before the camp.

If under 18, I, the guardian, authorise the administering of any medical or surgical treatment deemed necessary by a medical practitioner, in the event of an emergency. that I am not able to be contacted (Parent consent).
Do you accept the above? *
4. PARTICIPANT CONDUCT AGREEMENT

I acknowledge that by enrolling to participate in any YEP ACTIVITY, I will adhere to the following guidelines and rules which are necessary for the smooth running of events and to meet the Duty of Care requirements.

I further acknowledge that in the event of a breach of these guidelines my participation in the remainder of the event will be determined at the discretion of the YEP Coordinator. In such circumstances I accept responsibility for transport costs incurred.

1. Unless otherwise advised, MOBILES MUST be turned off during all activities and are not to be used in dorms at night.

2. SMOKING, ALCOHOL and DRUGS are NOT PERMITTED.

3. All MEDICATION musts be advised to event organisers upon arrival.

4. Sleep is essential if maximum benefit from the Camp is to be achieved.
Participants are expected to remain in their rooms after "LIGHTS OUT".
Full co-operation of all participants is expected.
Do you accept the above? *
5. PARTICIPANT CHECKS
A. Working with Children Check
Do you have a Working with Childrens Check?
If Yes, What is the expiry date?

- Day - Month Year
B. Police Check
Do you have a Police Check?
If Yes, What is the date of issue?

- Day - Month Year

Payment
Registration payments can be made as follows.

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Option 1 - Trybooking Online Payment (Preferred)

YEP Social Camp

YEP Annual Beach Retreat

Light to the Nations

Bourke Solidarity Camp

YEP Winter Sleepout

Year 9 Challenge Camp

YAM Young Adult Weekend

Note: Presently online payments is only available for camps listed here.

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Option 2 - Cash/Cheque sent to the YEP Office or Direct Debit

All Camps and Events

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Please see the YEP website for details after submitting this form.
What method do you intend to pay with? *

Acceptance and Submission
You have indicated that you are 18 years or older. Is this correct?
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You have indicated that you are not older than 18 years.

This means you have entered an incorrect age into the 'Personal Details' section of this form.

Please enter the correct age before proceeding.

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Please read the following legal conditions carefully.

- I have read and understood all of the above conditions
- I have completed all the relevant sections of the form
- I have correctly entered my current medical and dietary information
- I have correctly entered my age

By entering your name below you confirm that you understand and accept these legal conditions.
Electronic Signature - Applicant *

First Name Last Name
Application Completed *

- Day - Month Year
Electronic Signature - Parent Guardian *

First Name Last Name
Application Completed *

- Day - Month Year
By clicking the submit button, I certify that the facts contained in this application are true and complete to the best of my knowledge.

You may receive a message telling you that your jotform has not been received however this is false. If you're still unsure as to whether or not we received your registration, email us at yepmelb@gmail.com
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