Register Leader

Step through the registration process.

Payment Option*
The registration fee is $80 per person, or $50 per person if more than 1 person will be coming from your family. For payment, please use the payment option on this website, once registration is completed.
- I understand that registration will be $80 or $50 per person as described above.
Name*
First Last
Gender*
- Female
- Male
Address*
Street Address Address Line 2 City/Town State Postcode
Date of Birth*
Date Format: DD slash MM slash YYYY
Email*
Phone*
Working With Children Card*
Please indicate which type of card you have from Qld Govt Blue Card Services.
- Positive Notice Blue Card
- Exemption Card
Blue Card or Exemption Card Number*
If you have a working with children Blue Card or Exemption Card, please enter the Card Number.
Expiry Date*
Please enter the expiry date of your card. If your is an exemption card, leave this blank.
Date Format: MM slash DD slash YYYY
Organisation to Which Your Card Is Linked*
Please enter the primary organisation to which your card from Blue Card Services is linked.
Home Church*
Share room with
(person or group, if you have a preference)

Medicare Number*
Position on the card*
Please enter a number from 1 to 9.
Private Health Fund
Fund Member #
Last Tetanus Booster
Date Format: DD slash MM slash YYYY
Doctor Name & Phone*
Other relevant information
Allergies
Please list the specific details of any allergies you/your child has (e.g. insect stings, food, band aids, first aid treatments, drugs or other)
Medical Conditions
Please list the specific details of any medical conditions or illness you/your child has (e.g. asthma, epilepsy, hyperactivity, heart problems, diabetes or other)
Additional Needs
Please list the specific details of any conditions which require special attention or consideration from us (e.g. low vision, hearing loss, ADD or ADHD, behaviour issues, formal counselling situations, bed wetting, sleep walking or other)
Medications
Name and dosage of medications which may be required during activities (e.g. Ventolin, epi-pen or other) All medications must be personally administered. Note: non-prescription medications such as paracetamol (eg: Panadol) will not be provided or administered.
Dietary Requirements
Please list the specific details of any dietary requirements you/your child has (including food allergies and intolerances)
Swimming Ability*
How well can you swim?
- Cannot swim
- Fair Swimmer
- Good swimmer
General Restrictions
Please list the specific details of any activity in which you do not wish you/your child to participate, or that could cause anxiety to you/your child.

RELEASE STATEMENT