Young Adults Retreat 2025 • CityReach West Church

Registration 0

Individual's Contact Information

First Name *

Last Name *

Date of Birth *

Gender

Mobile Number *

Email Address *

Street Address *

Street Address Line 2

Suburb *

Postcode *

Medical/Dietary Information

Medical

Do you have any medical or psychological conditions that could impact you at camp? *

Have you ever had an anaphylactic reaction? *

Please specify: *

Dietary

If other, please specify:

Transport

Do you need help with transport to camp? *

Yes

Do you have room in your car to take others to camp? *

Yes

How many others? *

Emergency Contacts

Emergency Contact 1

Emergency Contact 1: Name *

Emergency Contact 1: Number *

Emergency Contact 1: Relationship to you *

Emergency Contact 2

Emergency Contact 2: Name *

Emergency Contact 2: Number *

Emergency Contact 2: Relationship to you *

Agreements

Protecting Your Privacy

Protecting your privacy is important to CityReach West. The information we seek allows us to manage risk, provide reasonable care and administer your involvement in our program. We are careful to keep your information confidential and provide it only to those agents acting on behalf of the organisation who need it to enable them to perform their agreed activities (eg. The first-aider in charge). You are welcome to contact us in relation to issues regarding your personal information and for a copy of our Privacy Policy. We only ask for information that is necessary for the purposes outlined in this statement. In some circumstances, if you don’t provide us with all the requested information, you could miss the opportunity to be involved in the camp.

Would you like to be contacted about CityReach Young Adults Camps in the future? *

Medical

All medication brought to camp by an individual is for their express use alone. Individuals are allowed to dispense their own medication for their own use on camp and maintain the security of their own medication at all times.

Do you agree with this medical statement? *

Indemnity

I acknowledge that risk of injuries is inherent in physical activities. While I am aware that workers will take all due care, I recognise that accidents may occur.

The workers have my authority to take whatever action they think necessary to ensure the safety, well-being and successful conduct of the participants as a group or individually in the abovementioned activity.
If I become ill or am accidentally injured, I agree that CityReach West may obtain on my behalf whatever medical treatment I require. I will agree to pay all such medical expenses.
I have included information in this form concerning my health including any relevant details of my limitations for the planned activity. I also acknowledge that CityReach West and all its representative leaders or other helpers at Young Adult's Camp can accept no liability for any personal injury or property loss suffered by me during the period of the event.

Do you agree to this statement? *

Media

CityReach West records the variety of activities that our participants engage in. We hope that photos that are taken can be used by us to further document/promote our activities. This may include, but is not limited to our Facebook page, placement on our webpage or placement on social media. In order to do this, we need permission to take your photos and use these images. If you do NOT want your image to be used in any of our promotional material, you need to indicate below. If you agree for you to have your image recorded, both as photographs and video footage, you:

Consent to my video/photo/other images taken by CityReach West for a range of public promotional purposes (both hardcopy and electronic) including publications, promotional material, websites and advertisements;
Acknowledge that any recording made by CityReach West of my image in connection with promotional activities is an authorised use for the purposes of the Copyright Act 1968;
Agree that my participation in promotional activities may be edited at the discretion of CityReach West;
Acknowledge that CityReach West is not obliged to include my images in the promotional activities;
Release CityReach West from any claim by me, or anyone on my behalf, arising out of my appearance in promotional activities;
Acknowledge that there is to be no payment or further consideration paid for my images.

Do you consent to the appropriate use by us of photographs of the CityReach West Young Adults Camp that include you? *

Behavioural Guidelines

Our main focus is to encourage and equip men in their faith in God and to do so in a safe environment. To help this happen, we all need to follow some guidelines to maintain a safe and healthy camp atmosphere. This may mean that you surrender your personal desires and live under firmer boundaries for the sake of the community. We have a set of guidelines designed to ensure that together we sustain a setting which supports individuals from diverse backgrounds and expectations.

Instruction from Leadership: Individuals should respect instructions given to them by those in authority and speak to the person privately if there is a concern. Serious issues should be discussed with the Camp Director. (1 Corinthians 1:10)
Respecting others: Treat all other individuals with respect and honour and do not participate in any anti-social behaviour. If an individual is an instigator or participant of inappropriate behaviour, they may be asked to leave by the Camp Director.
Damages: If an individual causes damage to the campsite or CityReach West's property, there may be a negotiation to cover the costs of repair.
Alcohol, tobacco, recreational drugs: No alcohol, tobacco or recreational drugs, of any kind, are to enter the camp site. This is to maintain the health and safety of all individuals, and ensure that the purpose of camp is not undermined.

Do you agree to these guidelines? *

Anything Else?

Is there anything else you would like to ask us / tell us? *

Please specify *

I, the individual listed above, acknowledge the above to be involved in the CityReach West Young Adults Camp.

Individuals Full Name as signature: *

Date Completed: *

We are committed to caring for you and protecting your privacy, so we collect information solely for the purpose of ministry and related activities of CityReach West. By completing this form, you consent for CityReach West to retain and process your information and contact you accordingly. To learn more, please see our Privacy Policy. If you have any further questions regarding this, please email contact@cityreachwest.church.

Details:

What to bring:

Location

Date & Time

Registration 0

Individual's Contact Information

Medical/Dietary Information

Medical

Dietary

Transport

Emergency Contacts

Emergency Contact 1

Emergency Contact 2

Agreements

Protecting Your Privacy

Medical

Indemnity

Media

Behavioural Guidelines

Anything Else?

I, the individual listed above, acknowledge the above to be involved in the CityReach West Young Adults Camp.