Ablaze Intergenerational Retreat Under 18 Registration

ABLAZE INTERGENERATIONAL RETREAT UNDER 18 REGISTRATION

"*" indicates required fields

ABLAZE INTERGENERATIONAL RETREAT UNDER 18 REGISTRATION

Registrant Name*

First Middle Surname (or family name)

Gender*

Male

Female

Date of birth*

DD slash MM slash YYYY

Does your child have a medical condition that we may need to be aware of?*

Yes

Give details of the medical condition*

PARENTS CONTACT

Preferred Parent Contact*

Mother

Father

Your Name*

First Last

Email*

We will send details for youth activities and any other important information to this email address

Contact Number*

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

Code of Conduct*

As a participant in the Darra Jindalee Youth Ministry ABLAZE Intergenerational Retreat, I understand and agree to the following in order to ensure a positive experience for all involved.

I will:

Treat all with respect and kindness and listen to what others have to say.

Treat other people’s personal space and property, and the venue property with respect.

Show respect during group activities, prayer time and Mass by not causing disruptions and not talking unless called on to respond.

Wear modest clothing.

Pay attention to and follow instructions given to me by the ministry leaders at all times and will make sure ministry leaders knows my whereabouts at all times.

Participate and contribute in a positive way in all group activities.

Not use rude or offensive language.

Not hurt, abuse, bully, or form inappropriate relationships.

Not use, possess or be under the influence of tobacco, alcohol, or banned drugs, or misuse other medication.

Tell an adult leader about anything that may make me feel worried, afraid or unsafe.

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 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

PARENTAL CONSENT

Retreat Contribution
The retreat contribution of $130 per person will cover the cost of food, accommodation and transportation. Please let us know if there are any financial constraints, so we can make arrangements for your young person 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 give consent for my young person to attend ABLAZE Intergenerational Retreat held at Tunnel Ridge Rance, 61 Kowald Rd, Landsborough QLD 4550 from Friday 26 June 2026 to Sunday 28 June 2026.

Parent/Guardian Name*

This field is hidden when viewing the form

Submission Date

MM slash DD slash YYYY