Derby STORMCo – WA Simple Events

Applicant Details

First Name

Last Name

Email

Phone

Date of Birth

Age at Event Date

Gender

Which church do you usually attend? (if any)

Are you a Pathfinder?

Yes

No

Which club are you a member of?

Have you been on a STORMCo trip before?

Yes

No

Which of our locations did you travel to?

T-Shirt Size

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

Applicant Questions

What can you contribute to a StormCo group?

Do you have any particular skills you could contribute? Music, drama, puppets etc.

How are you expecting to grow through StormCo?

What benefits do you expect the local community to be left with when your StormCo group leaves?

Medical Details

Please complete your medical and emergency details below.

All information is stored securely and accessed only by authorised personnel (i.e. trip 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

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 StormCo staff to provide:

Paracetamol

Yes

No

Ibuprofen

Yes

No

Anti-Histamine

Yes

No

Working With Children Check & Adsafe

Applicants aged 18 or above must:

– Have a valid Working With Children Check

– Have completed Adsafe Awareness Training within the past 3 years

– Have signed the Adsafe Code of Conduct

Working With Children Check – Website

Adsafe – Website

Working With Children’s Check Number

Working With Children Check Expiry Date

I have completed Adsafe Awareness Training within the past 3 years

I have signed the Adsafe Code of Conduct

Code of Conduct

As part of the STORMCo Team, I agree to:

– Be a representative of Christ at all times

– Always work as part of a team

– Respect all team members and the authority of those in leadership

– Be a positive influence in the community

– Keep safe – always make sure the team leaders know where you are

– Use positive affirming and clean language at all times

– Always be on time – this includes community appointments, team meetings and worships

– Dress modestly and appropriately for all occasions

– Displaying no actions of a romantic relationship outside of marriage

– Not let anything damage the team’s reputation

– Help resolve conflicts between team members quickly and virtuously, keeping the leaders informed of
any that arise

– Not promise any gifts, activities, return visits, etc to anyone in the community

– Stay focused on the mission of STORMCo and uphold its principals

– Respect the team’s privacy and security by not inviting or telling community persons where the team
is staying or anything in regards to team movements

– Not engage in rough physical play

– When engaging with children:

– Not touch a child in an age/culturally inappropriate manner

– Not to hold, kiss, cuddle or touch a child except for appropriate touch, eg – to comfort distress

– Not to spend time alone with a child

– Not to make sexually suggestive comments to a child including compliments about their physical
appearance

– Not to show or share sexually suggestive material to a child in any form such as email, text, movie
or sound file

– Not to assist children to do things of a personal nature that they can do for themselves

– Not to publish unauthorised photos, movies or private or identifiable information of a child
including online, without parental/guardian consent

I have read and fully understand the STORMCo Code of Conduct. I understand that if I choose to disregard these principles, I may be required to travel home immediately at my own expense. I understand that if I breach any state or federal laws that I may be reported to the authorities.

Applicant’s Consent

I wish to apply for this STORMCo trip. The information supplied on this form is true and correct. I understand that my application does not mean my acceptance onto a trip. Applications will be notified by email of their acceptance and allocation to a trip.

Taking photographs and video recordings of STORMCo activities has long been a part of STORMCo. Photographs and video recordings may be used for the purposes of promoting STORMCo and for memorabilia of team members. I consent to be photographed for this purpose.

I wish to apply for this STORMCo trip.

The information supplied on this form is true and correct.

I understand that my application does not mean my acceptance onto this trip.

Applicants will be notified by email of their acceptance and will be sent an invoice for the trip fee ($250).

Taking photographs and video recordings of STORMCo activities has long been a part of STORMCO. Photographs and video recordings may be used for the purposes of promoting STORMCo and for memorabilia of team members. I consent to be photographed for this purpose.

Parental Consent

I give permission for my child to apply for this STORMCo trip.

The information supplied in this application is true and correct

I understand that my child’s application does not mean their acceptance onto this trip.

Applicants will be notified by email of their acceptance and will be sent an invoice for the trip fee ($250).

Taking photographs and video recordings of STORMCo activities has long been a part of STORMCO. Photographs and video recordings may be used for the purposes of promoting STORMCo and for memorabilia of team members. I consent for my child to be photographed for this purpose.

Application Submission

Please note that submitting an application does not automatically secure your place on this StormCo trip. Your application will be reviewed by the Youth Department and you will be notified of the outcome via email. Upon application acceptance, an invoice for the trip fee ($250) will be sent to you for payment.

Derby STORMCo 2026

Trip Details

Application Details

Applicant Details

Parent/Guardian Details

Parent/Guardian #1

Parent/Guardian #2

Emergency Contact

Secondary Emergency Contact

Applicant Questions

Medical Details

General

Medical Conditions

Medical Contact (Optional)

Non-Prescription Medication

Working With Children Check & Adsafe

Code of Conduct

Applicant’s Consent

Parental Consent

Application Submission