PYV Big Day Out Registration Form
Bring along your family and friends and join us at the PYV Big Day Out for a day of full of fun, food and meeting friends, held at Ebenezer Presbyterian Church, Ballarat (map).

Please complete a registration form for each participant 12 to 18 years old. Adults and younger siblings are not required to fill out a registration form.
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Email *
Personal Details
First Name
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Last Name
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Date of Birth
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Year Level (this year - 2022)
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Home address (including number, street, suburb, state, postcode)
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Parent Mobile Phone
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Participant Mobile phone
Email
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Which Church do you attend  (if any)?
Please be advised that all attendees need to be accompanied by a responsible adult who will remain for the duration of the event.
Who will be responsible for your teenager at the Big Day Out?

Name:
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How many parents/adults and/or siblings under 12 will be attending with you?
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MEDICAL & DIETARY DETAILS
Dietary Requirements - please give details
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Medicare Number
*
Participants Number on Medicare Card (e.g 3)
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I have Ambulance Insurance
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Do you give permission for First Aiders to administer paracetamol if required?
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Does the participant have any medical conditions?
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If you ticked Yes to medical conditions, please give details and any measures required to reduce risk of harm/injury to the participant.
Emergency Contact Details
Emergency Contact Name
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Emergency Contact Relationship (e.g uncle)
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Emergency Contact Phone Number (mobile preferred)
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Emergency Contact Email
*
Do you give permission for photos, videos and audio taken of your child at PYV Events to be used for promotional and advertising purposes in print and online (including website, Facebook, Instagram, YouTube).
Note: If you tick No, please ensure the participant knows to step out of group photos taken by PYV leaders.
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Payment options will also be available on the day.
Clear selection
Other comments/details
Indemnity and parent consent
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Parent's Name (if participant is 17 and under)
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Date:
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