FEB 23: Young Life Adventure – Blue Mountains Hike

Join Young Life for a 7km hike along the Lockleys Pylon Track

Sunday, 23 February, 10:30am-2:30pm

Join us for a hike along Lockleys Pylon walking track. Just near Leura, this track is an invigorating walk offering awe inspiring views of the Grose Valley, outstanding photography opportunities and beautiful wildflower displays.

What to bring:

Drinking water, packed lunch, snacks, hat and sunscreen

Register here

Young Life Hike Adventure – Registration Form

Please enable JavaScript in your browser to complete this form.

- Step 1 of 4

What you will need to complete registration:
- Emergency Contact Details
- Medical Details
- Medicare Numbers & Family GP Details
- Allergy & Medication Details

Your Contact Details

Full Name *

First

Last

Email Address *

Mobile Number *

Date of Birth *

Emergency Contacts, Medical & Allergy Details

Emergency Contact Details

Full Name of Next of Kin (Primary Emergency Contact) *

Primary Phone *

Medicare Number *

Expiry Date *

Medicare reference number *

Medical & Allergy Details

Are you presently living with any illness, injury, or disability that may impact your ability to participate in the Adventurous Outdoor Activity that will be facilitated by Young Life Australia as part of this program? *

If yes, please provide details:

Do you have any allergies (drugs/foods/environmental/etc…)? *

What is the allergy/s, and what special care is recommended for these allergies?

Please provide detail

Are you currently taking any medication? *

If you are, please provide the name of the medication, the reason you take it, and whether or not you will require your medication during the Young Life Australia event.

Indemnity and Consent

Please read carefully and provide your consent.

Consent to medical attention: I, the undersigned confirm my consent to the activities I will engage in while on a Young Life activity or camp. I acknowledge the staff and volunteer agents of Young Life will take all possible care but cannot be held responsible for unforeseen accident or illness arising. I hereby consent to medical, hospital, rescue procedures being employed in the best interests of myself and that my emergency contact shall be notified as soon as possible should the continuance of such procedures be necessary *

Agree

Disclaimer: In the unforeseen event of personal injury or illness sustained while on a Young Life activity or camp, or the loss of personal property except where such property was held in the custody of Young Life staff or volunteer agents when lost while on a Young Life activity or camp, I hereby release, and exempt, and indemnify the organisers, sponsors, and all other persons involved in the organisation of the Young Life camp, trip, excursion, from all action, proceedings, demands, costs, expense, and claims whatsoever made or taken by any person arising out of my participation in such camp, trip, or excursion *

Agree

Media Consent: Young Life may take photos &/or video footage at Young Life activities and use for promotional purposes. Tick the box below if you agree to photos or footage of yourself being used *

Agree
Disagree

Your Registration is almost complete!

Your privacy: The personal contact/address details you supply on this form will be entered into our database. We may use it to send you further information about Young Life Australia. Young Life Australia adheres to the Privacy Act and will not disclose this information to third parties. If you would like to know what information Young Life holds about you please call 1300 557 647.

I consent to receiving information from Young Life Australia

Comment

MORE INFORMATION

Mike Peereboom, Adventure Coordinator

mikepeereboom@younglife.org.au

For weekly updates on Drop In and other news and activities

CHECK US OUT ON INSTAGRAM

For more adventures and updates @younglifeaus

Connect

PO Box 552
RYDE NSW 1680
1300 557 647
office@younglife.org.au

Facebook
Instagram
Mail

Foundation