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Name of Participant
First
Last
Gender
Male
Female
Email of Particpant
Please provide, IF the participant has an Email
Guardian & Emergency Contact Details
Fathers Name
First
Last
Father's Email
Father's Phone number
Mother's Name
First
Last
Mother's Email
Mother's Phone number
Date of Birth (DOB) of Participant
DD slash MM slash YYYY
Country
Australia
New Zealand
State
VIC
NSW
QLD
SA
WA
TAS
ACT
NT
Other
Parish/Mission
Melbourne Cathedral
Melbourne South East
Melbourne West
Shepparton
Bendigo
Ballarat
Melbourne
Wodonga
Geelong
Sunraysia Mildura/Wentworth
Sydney/Villawood
Newcastle
Orange
Wollongong
Terrey Hills
Parramatta, Blacktown
Penrith NSW
Wagga Wagga
Campbelltown
Bowral
Nowra
Gosford
Wyong
Taree
Sydney Knanaya
Brisbane South
Brisbane North
Cairns
Townsville
Toowoomba
Springfield
Ipswich
Gold Coast
Sunshine Coast
Brisbane Knanaya
Bundaberg
Caboolture
Adelaide South
Adelaide North
Adelaide Central
Canberra
Goulburn
Canberra
Perth
Perth Knanaya
Hobart
Darwin
Alice Springs
Auckland
Hamilton
Palmerston North
Wellington
Christchurch
Dunedin
Singapore
PNG
Other
Dietary requirements of participant
Write NA if you have no dietary requirements
Medical requirements Particpant
Write NA if you have no medical requirements
Registration Type
Participant
Animator/Senior
Terms and Condition – The Program Code of Conduct and Age Restriction
Qadosh: It is a three/four-day residential programme for the teenagers led by the Youth Apostolate of the Syro-Malabar Eparchy of St. Thomas the Apostle, Melbourne. Qadosh is an exclusive (fun, fellowship and faith) programme for teenagers, and it will help the participants encounter Christ so that they can excel in their lives.
As a Guardian of this participant, do hereby grant permission for my child to participate in the ‘Qadosh’ lead by Youth Apostolate for the teenagers.
I understand that all activities will be supervised by volunteers of the Youth Apostolate of Syro-Malabar Eparchy, of the mission and will take reasonable steps to provide a safe environment for my child and to ensure that all equipment supplied for all activities is of a safe standard.
I acknowledge that the Parish/ Mission & the Youth Apostolate will not be liable for any unexpected injury that may be suffered by my child during the activities. In the case of an emergency, I give consent to Parish/ Mission & Youth Apostolate of Syro-Malabar Eparchy to seek required medical care and assistance.
I also understand that I will be liable for any medical expense incurred due to any emergencies
I agree that Parish/ Mission, Youth Apostolate, its volunteers, staff and leaders, shall not be held liable for any injury, damage or loss of personal property arising from and/or connected with this event.
I understand that by registering my child for this event I give Parish/ Mission & Youth Apostolate permission to take and use images and/or footage of my child at this event for promotional purposes in the future.
I understand that youth apostolate demonstrates due diligence when conducting overnight camps and all efforts will be made to ensure a safe emotional and physical environment for children and young people.
By participating, you confirm that you have read, understood, and agree to these terms.
Terms and Condition – Privacy Statement
Privacy and Security of Information Provided by Participants:
1. YA take reasonable steps to protect privacy and safety of information provided.
2. We do not store credit card information on our website.
3. We use a third-party payment processor with secure payment technology for all transactions held on our site.
4. We do not, at any time, hold or store any credit card information or personal data on our website.
5. By accepting this, you consent to YA using your data for marketing purposes.
By participating, you confirm that you have read, understood, and agree to these terms.
Consent – Media and Medical
Media Consent
By participating in this program, you acknowledge and agree to the following:
1. Permission to Record: You consent to the recording of your image, voice, and/or likeness by Youth Apostolate/SMYM through photographs, video recordings, audio recordings, and other media formats.
2. Usage Rights: You grant Youth Apostolate/ SMYM the unrestricted, royalty-free, and perpetual right to use, reproduce, publish, and distribute such recordings in any media or format, including but not limited to websites, social media, promotional materials, and publications.
3. Scope of Use: The recordings may be used for various purposes, including but not limited to marketing, educational content, promotional activities, and public relations.
4. Waiver of Claims: You waive any claims to compensation or rights to review or approve the final product in which your image, voice, or likeness may appear.
5. Opt-Out Option: If you do not wish to be recorded or if you have any concerns about the use of your media, please contact us at teens.ya@syromalabar.org.au prior to the event.
Medical Treatment Consent
I give permission for YA to obtain emergency medical, hospital or ambulance assistance and/or treatment for the delegate at any time they consider necessary. I acknowledge that I will be liable for any medical, hospital or ambulance expense incurred in the treatment, and I agree to pay those expenses. I have informed YA of any allergies or other medical conditions that are relevant to this activity and will make any necessary medication available.
By participating, you confirm that you have read, understood, and agree to these terms.
Signed Parental Consent form
Please attach a signed copy of the parental consent form here if you are under 18 and have graduated Year 12.
Accepted file types: pdf, Max. file size: 80 MB.
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