Youth Rush- Darwin – na.bluevineyardevents.com

Accommodation: Darwin Seventh-day Adventist Church (80 Cavenagh St, Darwin City NT 0800)

Guest Speakers/Leaders: Josh & Mary Fawcett from New Zealand, and Pr Harley Southwell (during the first week of training).

*Please note: If you are flying into Darwin, please advise Karen Gallo so bedding/linen can be arranged.

NAC Youth Rush- Darwin

Personal Information

First Name

Last Name

Gender

Date of Birth

Mobile

Address

Address Line

Suburb

State/ Territory

Postcode

Age at Youth Rush

Church you attend

Are you a baptized member of the Seventh-day Adventist Church?

Yes

I give consent to photographs and videos being taken of my child at the NAC Youth Rush for the purpose of advertising and promotion in various media within the Northern Australian Conference. People pictured will NOT be named when using these photos & videos:

If you are 18 years or older, please complete the following:

Do you have a WWCC/ Blue Card (QLD)/Ochre Card (NT)?

Ochre Card/ Blue Card/ WWCC (Number)

Ochre Card/ Blue Card/ WWCC (Expiry)

Attendees under 16 years of age

If you are under 16 years of age, you must attend this event with a nominated guardian. Please complete the following questions to confirm your registration.

*Please Note: Your guardian must also register for this event

Name of your guardian for Youth Rush

Guardian’s Phone/Mobile

Guardian’s Email Address

Medical Information

Medicare Number

Position on Medicare Card

Medicare Card (Expiry)

Please list below any known medical conditions or care notes, including:
allergies (anaphylactic & non-anaphylactic), eating disorders, asthma, autism, bed-wetting, blackouts/ dizziness/ fainting, bleeding disorder, diabetes, disability, eczema/ skin condition, epilepsy/ seizures, hearing impairment, heart condition, joint/ muscle/ bone problems, migraines, operations, phobia, recent illness, sleep walking, sight impairment, travel sickness, mental health issue. heart problems, respiratory problems, travel sickness, any other medical issue or care note.

Please email all action plans (i.e. anaphylaxis, asthma, diabetes) to Karen at nacliterature@adventist.org.au

Do you have any medical conditions? (Please write N/A if not applicable)

Do you take any medications? (Please write N/A if not applicable)

Do you have any allergies? (Please write N/A if not applicable)

Do you have any dietary requirements? (Please write N/A if not applicable)

Emergency Contact

Emergency Contact Name:

Emergency Contact Number:

Emergency Contact Email:

Relationship to attendee?

About you and the program

What do you hope to gain from this experience?

Have you had any experience with canvassing/doorknocking? If so, tell us about this experience.