Hello! Welcome to Club! We need to know a bit about you… Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Young Life Club or Area: *Please chooseArmidaleBarossa ValleyBlacktownCanberraHobartMelbourneParramattaRedlandsRydeDon't KnowAttendee's First and Last Name: *FirstLastDOB: *Child's Gender: *[Please Select]FemaleMaleTransgenderNon-binary/non-conformingPrefer not to sayChild's Email:Child's Mobile:School: *Parent/Carer/Guardian with whom the attendee primarily resides: *FirstLastResidential Address: *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryEmail: *Mobile: *Home:Work:Secondary Parent/Carer/Guardian/Emergency contact: *FirstLastSecondary Email:Secondary Mobile: *Secondary Home:Secondary Work:Medical InformationMedicare no: *Expiry Date: *Child position on card: *Allergies: *Medical conditions you would like us to be aware of: *Other issues or concerns:Please Note!It is your responsibility to provide your child with medication they require. Young Life Australia does not provide medication at their weekly events. By signing this form, you acknowledge that if you child requires any medication, including for emergency situations, that you will send your child with what is required weekly and provide the Young Life staff person in charge of the event with the instructions for use.Permission and Consent: *I give permission for my child to attend a Young Life Club.I give permission for my child to be transported home by the Young Life team if needed.Consent to medical attention: I, the undersigned confirm my consent to the activities my child will engage in while on a Young Life activity or camp. I acknowledge the staff and volunteer agents of Young Life Australia 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 my child and that I shall be notified as soon as possible should the continuance of such procedures be necessary. *I agreeDisclaimer: 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 child’s participation in such camp, trip, or excursion.I agreeDiscipline: If in the event your child's behaviour is deemed by the organisers to be inappropriate or compromises the safety and/or health of other attendees at the Young Life activity, on the camp, trip or excursion, then Young Life reserves the right to send your child home, at your expense, at the earliest possible time, by the most effective mode of transport, in conjunction with your co-operation.I agreeMedia Consent: Young Life Australia may take photos/video of your child to to use for promotional purposes.I agreePrivacy: 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 agree to receiving information from Young Life AustraliaSignature: * Clear Signature Date: *If you have any questions or concerns about Young Life in your local area, please contact the National Young Life Office.P: 1300 557 647 E: office@younglife.org.au W: younglife.org.au F: facebook.com/younglifeaustraliaSubmit More parent info Local Young Life contact info