Ashes 2 Green Registration Form February 2022

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this registration form for EACH person attending and we will be in touch with you closer to the event with practical details such as transport information and what to bring. Young people under the age of 18 will require parents permission to complete and electronically sign this form.

Email *

Name of Participant *

How did you hear about this Event? *

Option 1

Name of Parent (if under 18 years of age) *

Address *

Phone *

Emergency contact and phone number *

How have you been affected by the recent Nambucca Valley Fires/ Floods of 2019/2020/ 2021? *

Please list any dietary requirements

Please list any medical alerts or allergies (including food allergies, insect bites/ stings and any relevant medication you carry). Notify us if you carry an Epipen or if you need assistance with medication.

Do you have any mobility issues, vision or hearing impairments? (if yes - please provide details)

Permission to take photographs/ video for website/ facebook/ promotions *

Yes

Do you require transport from Bowraville township to and from the venue? *

Yes

Required

Consent to attend from Parent (If under 18 years of age)

Yes

Clear selection

Responsibility clause

Please read the following statement carefully:

All participants are expected to act responsibly at all times and attend Spirit of the Rainforest at their own risk. This includes riding on the bus (if used.) Each participant, in registering to attend, waives any right to make any claim or bring any action whatsoever against the organisers, the facilitators or other participants for any loss, damage or injury howsoever occurring. The organisers make no representation whatsoever regarding the efficacy of their programme or it’s benefits, or the safety or the suitability of the facilities. Each participant takes responsibility for his/her own participation, health and safety, and must act in a safe and responsible manner at all times. This information is accurate and complete. I agree to communicate fully to the organisers any health concerns that may arise. I understand that the organisers will seek emergency medical treatment for me in the event that I am unconscious or unable to make my own decisions. I understand that should I need medical care for any reason while participating in this program the role of organisers will be limited to emergency ﬁrst-aid (including the administration of paracetamol if required) and either transportation to the nearest medical facility, or contacting emergency medical assistance. I have read, understood, and agree to the above statement regarding self-responsibility. *

Yes

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms