2025 Teen Catalyst – wa.bluevineyardevents.com

Attendee Details

First Name

Last Name

Email

Phone

Date of Birth

Age at Event Date

Gender

Which Church do you attend?

Parent/Guardian Details

Parent/Guardian #1

First Name

Last Name

Email

Phone

Relationship to Attendee

Add another parent/guardian

Yes

No

Parent/Guardian #2

First Name

Last Name

Email

Phone

Relationship to Attendee

Emergency Contact

First Name

Last Name

Phone

Relationship to Attendee

Secondary Emergency Contact

First Name

Last Name

Phone

Relationship to Attendee

Medical Details

Please complete your medical and emergency details below.

All information is stored securely and accessed only by authorised personnel (i.e. event leaders, first aiders).

For event safety, it is vital that the information is up to date when the event begins. If you have any questions or would like to update the medical information you provide, please do not hesitate to contact us at wayouth@adventist.org.au

General

Medicare Number

Position on Medicare Card

Do you have ambulance cover?

Ambulance Cover Provider

Do you have private health insurance?

Private Health Insurance Provider

Private Health Insurance Member Number

Do you object to transfusions?

Date of last tetanus vaccination

Any non-medical dietary requirements?

Please advise any other non-medical dietary requirements

Medical Conditions

Please list below any known medical conditions or care notes, including:
allergies (anaphylactic), allergies (non-anaphylactic), anorexia/ eating disorders, asthma, autism, bed-wetting, blackouts/ dizziness/ fainting, bleeding disorder, diabetes, disability, eczema/ skin condition, epilepsy/ seizures, hearing impairment, heart condition, joint/ muscle/ bone problems, migraines, operations, phobia, recent illness, sleep walking, sight impairment, travel sickness, mental health issue. heart problems, respiratory problems, travel sickness, any other medical issue or care note.
Please email all action plans (i.e. anaphylaxis, asthma, diabetes) to wayouth@adventist.org.au

Add medical condition/care note

Medical Condition/Care Note 1

Symptoms

Triggers

Medication

Care Instructions

Add another medical condition/care note

Medical Condition/Care Note 2

Symptoms

Triggers

Medication

Care Instructions

Add another medical condition/care note

Medical Condition/Care Note 3

Symptoms

Triggers

Medication

Care Instructions

Add another medical condition/care note

Medical Condition/Care Note 4

Symptoms

Triggers

Medication

Care Instructions

Medical Contact (Optional)

Add doctor’s details

Doctor’s Name

Practice Name

Phone Number

Non-Prescription Medication

Should my child feel unwell, I give permission for the Teen Catalyst staff to provide:

Paracetamol

Yes

No

Ibuprofen

Yes

No

Anti-Histamine

Yes

No

Ticket Selection

I am being sponsored by my local church

Yes

No

Teen Catalyst – Attendee Fee

Attendee Fee – $180

Teen Catalyst – Sponored Attendee Contribution

Registration Submission

The information supplied in this registration form is true and correct.

I have read and agree to the Terms and Conditions and Privacy Policy

What to Expect

Cost & Sponsorship

Attendee Details

Parent/Guardian Details

Parent/Guardian #1

Parent/Guardian #2

Emergency Contact

Secondary Emergency Contact

Medical Details

General

Medical Conditions

Medical Contact (Optional)

Non-Prescription Medication

Ticket Selection

Registration Submission