Summer Camp 2025- Staff Rego

Attendee Information

First Name

Last Name

Gender

Address

Address Line 1

Address Line 2

Suburb

State/Territory

Postcode

Postal Address (if different to above address)

Contact Number

Age at Camp

Church You Attend

Church Pastor:

Blue/Ochre Card or WWCC Number (Please type N/A if you are not yet 18):

Blue/Ochre Card or WWCC Expiry (Please type N/A if you are not yet 18):

Have you completed both your “Adsafe- Code of Conduct” & “Adsafe- Awareness Training” online modules:

The Northern Australian Conference is fully committed to the protection of Children and Vulnerable Adults. You are making an application to work as a volunteer in an important child related role. Please be aware that according to Adsafe Policy:

Your name will be screened with Adsafe before any appointment is made. Adsafe maintains a database of persons who represent a heightened risk when working with children. If you are not willing for your name to be screened, please discontinue your application.
If you are appointed, and prior to commencing the role, you will need to:
1. Complete Adsafe Awareness Training;
2. Sign the Adsafe Code of Conduct; and
3. Show evidence that you have a current Working with Children Check clearance (NSW, Vic, SA, WA) or

show evidence that you have current Blue Card (Qld) or

show evidence that you have current Working with Vulnerable People registration (ACT, Tas)

Please be aware that in the ACT, NSW, Tasmania, Victoria and Western Australia your appointment to this role will mean that you will come under the relevant Reportable Conduct Scheme. This means that if certain allegations are raised about your conduct they will be investigated.

Preferred role at Camp:

If you selected ‘Other’, please list here:

Please Note: This is a preference only. You may be allocated a different role at Camp should your assistance be required elsewhere.

Emergency Contact

First Name

Last Name

Relationship to attendee

Contact Number:

Contact Email

Medical Information

Date of Birth

Swimming Ability (please select)

Medicare Card (Number)

Medicare (Position Number)

Medicare (Expiry)

Year of your last Tetanus Injection:

Are your immunisations up-to-date?

Please provide details as necessary. If not applicable to you, please write N/A.

Dietary Requirements:

Allergies & your reaction:

Medication:

Other Medical Conditions:

Photo Consent

I give consent to photographs and video being taken of me at Summer Camp 2025 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:

Camp Shirt

Transport

Please select from the following:

Camp Registration Fee

Payment Item

Staff Registration Fee

No payment items has been selected yet

Pay with Card (Stripe)

First Name

Last Name