Soul Survivor Youth Convention
Instructions for registration process.
Step 1: FILL IN ONLINE APPLICATION
Fields markd with an * MUST be filled in for the application to submit. Use upper AND lower case for each field; eg, Bree Mills (CORRECT), bree mills (INCORRECT)
Step 2: PRINT OUT eFORM
Once your data is sucessfully submitted, check your emails for a Confirmation Email. Print out the ENTIRE email (eForm) including all User Submitted Data. Check the User Submitted Data for any errors and make any necessary corrections on the eForm. Sign eForm.
Step 3: MAKE PAYMENT
Fill in the Payment Calculation and Payment Method sections of the eForm and arrange for payment. eForms and payments MUST be submitted by the cut-off dates to claim Early Bird or Standard rate convention fees.
Step 4: SUBMIT APPLICATION & PAYMENT
Return the ENTIRE signed eForm (including ALL User Submitted Data) together with your payment. Your Soul Survivor Convention Application is now complete
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Participants Details
First Name
*
Surname
*
Address
*
Suburb
*
Postcode
*
Home Ph:
Participants Mobile No
E-mail
*
School Year
*
Please Select
Grade 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Leader
School
Gender
*
Male
Female
Date of Birth
*
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Parent Details for Correspondance
Parent/Guardian Name
*
Parent Guardian Name
*
Parent Mobile
Parent email
*
Emergency Contact 1
Emergency Contact Name
*
Home Phone
*
Mobile Phone
Email
Relationship to Participant
*
Emergency Contact 2
Emergency Contact Name
*
Home Phone
*
Mobile Phone
Email
Relationship to Participant
*
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Medical Details
Medicare Number
*
Expiry Date
*
Doctors Name
*
Doctors Address
*
Doctors Phone Number
*
Health/Ambulance Fund Name
Health/Ambulance Fund Number
Does the participant have any dietry requirements
*
Yes
No
Please specify
Is the participant known to have
Diabetes
Fits of any type
Dizzy spells
Blackouts
Travel Sickness
ADHD or similar
Heart Condition
Asthma
Migraines
Epilepsy
Bed Wetting
Sleep Walking
Aspergers Syndrome
Learning Difficulties
Allergies
Other
Please provide details
Will the participant be bringing any medication to the camp
*
Yes
No
If Yes, please provide details
Who will administer the medication
Please Select
Participant
Leader
Family Member
Do you OBJECT to panadol being given for minor pain or headaches?
*
Yes
No
Has the participant had any recent illnesses or operations
*
Yes
No
If Yes, please specify
Date of participants last tetanus immunisation (if known)
*
Please rate the participants swimming ability
*
Please Select
Poor
Fair
Good
Excellent
Is there any other information about the participant that you should disclose in order to protect their, or others, health, safety, comfort, or wellbeing?
Yes
No
If Yes, please specify
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Registration confirmation
I understand that my camp registration is NOT confirmed until I have returned my signed eForm containing Consent & Payment details.
*
Yes
I understand that my camp registration is NOT confirmed until my payment has been received in full by the due date.
*
Yes
Once you click on the "Submit" button, your information will be sent directly to our secure GWAC camp Database. To confirm that your information has been properly submitted, an email (eForm) will be immediately sent to the addresses you provided above. Please print out the ENTIRE eForm and continue the registration process. Thank You
Submit Form
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