Ablaze Intergenerational Retreat Over 18 Registration

ABLAZE INTERGENERATIONAL RETREAT ADULT LEADER/PARTICIPANT REGISTRATION

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ABLAZE INTERGENERATIONAL RETREAT ADULT LEADER/PARTICIPANT REGISTRATION

Registrant Name*

First Middle Surname (or family name)

Gender*

Male

Female

Date of birth*

DD slash MM slash YYYY

Email*

We will send details for the retreat and any other important information to this email address

Contact Number*

Do you have a medical condition that we may need to be aware of?*

Yes

Give details of the medical condition*

EMERGENCY CONTACT DETAILS

Emergency Contact Name*

First Last

Emergency Contact Number*

RESIDENTIAL ADDRESS

Unit Number

Street Name & Number*

Suburb*

State*

POLICY DETAILS. Please read and tick each section before signing. The Darra Jindalee Catholic Parish operates in accordance with the following policies:

Safeguarding Children and Vulnerable Adults Policy*

I understand and agree that Darra Jindalee Catholic Parish upholds and complies with the Safeguarding Children and Vulnerable Adults policy of the Archdiocese of Brisbane. Further details are located here: https://brisbanecatholic.org.au/support/safeguard/

I have read and understood the above statement

Adult Code of Conduct*

All Adult Leaders/Participants are required to have read and be familiar with the Archdiocese of Brisbane - Archdiocesan Ethical Code of Conduct. Please refer to Pat Casey the Volunteer Coordinator: volunteers@bne.catholic.net.au, should you require further clarification:

I will:

Conduct myself in a Christian manner through language, dress and behaviour and be a positive role model to promote the values of the Catholic Church through my words and actions

Act in accordance with federal laws, and the laws, regulations and rules of the State/Territory in which the activity is hosted.

Treat everyone with respect, loyalty, patience, integrity, courtesy, dignity, and consideration.

Avoid all forms of discrimination and respect the dignity of each person without regard to economic status, age, gender, race, ethnicity, religion, sexual orientation, or physical or mental abilities.

Use positive reinforcement and communication rather than criticism, unhealthy competition, or comparison.

Adhere to emergency plans and evacuation routes appropriate to the venue and adhere to all instructions provided by ministry leaders.

Uphold the authority of those responsible for the program or activity in which I am participating.

I will not:

Engage in any inappropriate conduct.

Upload, post on social media or transmit via a mobile device embarrassing or inappropriate photos of myself or others.

Use, purchase, possess, distribute, or be under the influence of illegal drugs, substances or alcohol at any time.

Purchase, download, possess, or distribute pornography.

Participate in, or tolerate behaviour which humiliates, ridicules, threatens or degrades others.

Use physical discipline in any way for behaviour management of others. No form of physical discipline is acceptable. This includes but is not limited to slapping, pinching, shaking, hitting or any other physical force as retaliation or correction for inappropriate behaviour.

Use rude or offensive language in the presence of others.

I hereby represent that I am not currently being investigated for, nor have I ever been convicted of an offence against any person whether an adult or minor (including but not limited to murder, assault, battery, sexual assault, injury to a minor, and abandoning or endangering a minor); I have never been terminated from employment or a volunteer position for reasons related to allegations of physical or sexual abuse by me; nor have I sought or received any medical, physical, or psychological treatment for reasons involving physical or sexual abuse by me. I understand that should my response to any of the statements above change, I am obligated to inform Darra Jindalee Catholic Parish/Darra Jindalee Youth Ministry immediately.

Moreover, I understand that should I admit to or be found guilty of an incident of sexual misconduct or other offence against any person (as noted above), or if it appears that an alleged claim is substantiated; my involvement with the activity shall be immediately terminated.

Further, I understand that my failure to agree to and abide by the Adult Code of Conduct will bar me from participating in the activity.

I have read the above Code of Conduct and agree to follow it. I understand that if the Code is breached then the Darra Jindalee Catholic Parish/Darra Jindalee Youth Ministry may:

Report my misconduct to local statutory authorities, if the breach in any way violates local ordinances or laws

Dismiss me from the activity

Ban me from involvement in future events

I have read and understood the above statement

Indemnity*

I understand that while every reasonable pre-caution will be undertaken to ensure the protection of my child, I hereby release Darra Jindalee Catholic Parish/Darra Jindalee Youth Ministry from any and all liability in the event of any injury, accident, misfortune, damage, or loss whatsoever that may occur to my child or their property while present at the ABLAZE Intergenerational Retreat at Tunnel Ridge Rance.

I have read and understood the above statement

Medical Treatment Consent*

In the event that you are unable to communicate with me, or my nominated emergency contacts, I consent for my child to receive any such medical or surgical treatment as may be deemed necessary and I agree that any such treatment will be at my expense. I consent for my child to receive First Aid. I have informed you of any allergies or other medical conditions of my child relevant to this activity and will make any necessary medication available.

I have read and understood the above statement

Wellbeing*

I understand and agree that Darra Jindalee Catholic Parish may provide food and drinks at events, and participants may be engaged in games and sports from time to time. It is the responsibility of individuals and parents/guardians of minors (under 18) to advise of any allergies, illnesses or conditions which may impact participation to ensure appropriate safeguards are in place.

I have read and understood the above statement

Involvement Consent*

I give permission for my child to participate in activities he/she may choose while attending the ABLAZE Intergenerational Retreat at Tunnel Ridge Rance. Darra Jindalee Catholic Parish/Darra Jindalee Youth Ministry reserves the right to remove my child from this event at their discretion, and that I will be responsible for collecting him/her from the venue if required.

I have read and understood the above statement

Media Release*

I grant to the Catholic Archdiocese of Brisbane, its representatives and employees the right to take video footage and photographs of my child to be used in connection with Darra Jindalee Catholic Parish/Darra Jindalee Youth Ministry ABLAZE Intergenerational Youth Led Retreat at Tunnel Ridge Rance. I authorise the Archdiocese, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that the Archdiocese may use such footage or photographs of me in perpetuity with or without my name and for any lawful purpose, including for example sure purposes as publicity, illustration, advertising, and Web content. I understand that I can personally request photos and videos not be taken or used by contacting the parish office at darjin@bne.catholic.net.au or by telephoning 07 3324 3630.

I have read and understood the above statement

ADULT LEADER/PARTICIPANT CONSENT

Retreat Contribution
The retreat contribution of $130 per person will cover the cost of food as your accommodation has been funded. Please let us know if there are any financial constraints, so we can make arrangements ahead of time. Please deposit $130 to:

Darra Jindalee Catholic Church
BSB: 064 786
ACCOUNT: 100000351
REF: Name and Retreat

By submitting this form, I will be participating/attending ABLAZE Intergenerational Retreat held at Tunnel Ridge Rance, 61 Kowald Rd, Landsborough QLD 4550 from Friday 26 June 2026 to Sunday 28 June 2026.

Participant Name*

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Submission Date

MM slash DD slash YYYY