YOUTH CONFERENCE REGISTRATION FORM Youth Registration- This by alendar


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									                                                                                                YOUTH CONFERENCE REGISTRATION FORM
                                                                                              This is a YOUTH registration form to be completed by all
                                                                                              persons attending the youth conference who are apart of a
                                                                                              youth group attending the Planetshakers Conference. This form
                                                                                              is to be authorised by their legal parent/ guardian and returned
                                                                                              to the youth group leader as a record of consent to attend
                                                                                              Planetshakers Conference 2009.
STEP 1 – REGISTRATION TYPE- Please indicate                                                  STEP 5 – ACCOMODATION & CATERING- youth groups only
                                                                                             Conditions Apply. More information is available at
    Youth Registration- This registration is for youth under the age of 18
    Youth leader registration – This registration is for youth leaders                       Do you require Budget Accommodation                              Yes - $25 per person                    No
attending with their youth group. This entitles the delegate to attend both
                                                                                             Do you require Budget Catering?                                  Yes - $85 per person                    No
the youth and adult conferences. Only youth leaders attending with their
groups are eligible for this registration                                                    Do you have any special requirements? (Food allergies, vegetarian etc)
STEP 2 – REGISTRANT DETAILS (please complete for the person attending event)
Title:        Mr.        Mrs.        Miss    Ms.
                                                                      STEP 6 – ELECTIVES (choose ONE elective from the conference attending)
             Other _____________________________                      18+ Conference Electives
First Name: _____________________________________________________       Kingdom Business & Finance                 University & Intl. Students
                                                                        Worship & Creative Ministries              Leadership
Surname: _____________________________________________________
                                                                        The Empowered Life                         Social Justice
Gender:      Male     Female    Date Of Birth: ____ /____/___________ Youth Conference Electives
                                                                        Evangelism                                 High School Ministries
Address: _______________________________________________________
                                                                        Worship & Creative Ministries              Leadership
City/Suburb: ____________________________________ State: __________     The Empowered Life                         Justice Generation
Postcode/Zip: _____________ Country: ______________________________                          STEP 6 – PAYMENT CALCULATION & METHOD
Ph (Home): ____________________________________________________                              Registration Cost             $________.____
Ph(Mobile):_____________________________________________________                             Budget Accommodation                                        $________.____
Email: _________________________________________________________                             Budget Catering                                             $________.____
Emergency Contact                                                                            TOTAL COST                                                  $________.____
Name: _________________________________________________________ PAID:                                                                                             Yes          No
Relationship: ____________________________________________________ STEP 7 – GENERAL TERMS & CONDITIONS
                                                                                             Planetshakers Ministries International Incorporated (hereinafter know as ‘Planetshakers’). Disclaimer: I
Phone Number: _________________________________________________                              acknowledge that if I am a youth leader or church leader and have completed this form on behalf of a person
                                                                                             under the age of 18 years of age I have done so with the permission and consent of the child’s parent/guardian
STEP 3 – TYPES OF REGISTRATION                                                               and have been given the responsibility of caring for the child whilst at the conference and take full responsibility
                                                                                             for the child. If I am a parent/guardian of a child attending the conference, I hereby confirm and acknowledge
*Group leaders must purchase registrations online to secure the current registration price   my child attends at their own risk and I allow this with full knowledge of the risks associated and confirm my
                                                      Youth               Youth Leader       child is not the responsibility of Planetshakers, its employees, servants, agents or volunteers. Planetkids Program
                                                                                             is available for children aged 2 years – 11 years of age (at time of conference start) of fully registered delegates
                                                  Registration             Registration      of either the Youth or Adult Conference. The parent or guardian of children aged between 2 – 4 years will need
                                                                                             to be at the conference venue to sign the child in each day. Planetkids program runs during conference sessions,
 Super Early Bird Registration                                                               including during the morning break and electives. Parents need to collect children over the lunch time break and
                                                       $50                    $110
 Until 20 Nov 2008                                                                           after electives, before the evening session. Planetshakers recommends that you confirm your registration with
                                                                                             our office prior to booking any flights and/or accommodation. Planetshakers does not accept any responsibility
                                                                                             for losses incurred for flights and/or accommodation booked for the conference. Planetshakers reserves the right
 Early Bird Registration
                                                       $80                    $145           to change any of the published conference details without notice and have the final say on any matter relating to
 21 Nov – 16 Feb 09                                                                          the conference. These conditions also apply to the budget accommodation provided by Planetshakers Conference
                                                                                             and if you have selected this service you agree to comply with these conditions. Indemnity: I hereby agree to
                                                                                             indemnify, release and hold harmless Planetshakers, its employees, servants and volunteers against any and all
 Full Price Registration                                                                     claims arising from, or in connection with, any injury, accident, misfortune, damage or loss that may occur to
                                                      $100                    $170
 17 Feb- 16 Apr 09                                                                           myself/my child and/or my/their property, equipment or personal effects while present at the Event and within
                                                                                             the Event premises, including any injury that my child may cause to another person. Refunds/Transfers’: No
STEP 4- PLANETKIDS PROGRAM                                                                   refunds will be paid. Individual registrations can be transferred to another individual by placing the request in
                                                                                             writing to the Planetshakers Office, Registration Manager. Group Leaders can transfer/reallocate registrations
*Prices are set per child for the Planetkids program and do not vary for multiple children   online and don’t need to place any requests with the Planetshakers Office. Gst/Receipts: The registration price
                                                No. of Children           Total price        does not include GST as the conference is considered a ‘Religious Service’. Should you require a tax invoice for
                                                                                             your records, please photocopy this registration form prior to returning it to us. Medical Treatment Consent:
 Per child $30                                                                               I give permission for Planetshakers authorised staff and volunteers to obtain emergency medical, hospital or
                                                   ________              $_________          ambulance assistance at any time they consider necessary. I understand that every effort will be made for the
                                                                                             registrant or my emergency contact listed above to be notified before instituting such procedures. I acknowledge
                                                                                             that I will be liable for any and all medical/hospital/ambulance costs and expenses incurred in the registrant’s or
1.    Child Name:____________________________ DoB ___ /____ /______                          my child’s treatment. Transport Consent: I consent to Planetshakers providing transport for my child to and
                                                                                             from the venue and activities as set out in the curriculum for the day and I understand Planetshakers will take all
      Does your child have any medical concerns or allergies?              Yes       No      reasonably practicable steps to provide a safe environment for my child and ensure all vehicles are in a safe and
                                                                                             in working order. Involvement Consent: I hereby give my consent for the registrant to participate in activities
      Please note any medical conditions or allergies:                                       they may choose while attending the conference. I agree and understand that Planetshakers reserves the right
                                                                                             to exercise its discretion to refuse to register any person upon medical and/or other grounds, without providing a
                                                                                             detailed reason for so doing. Swimming Consent: I give consent for my child to participate in swimming or
      __________________________________________________________                             aquatic activities. I understand that Planetshakers authorised staff and volunteers will be present and provide
                                                                                             supervision for safety. I understand that the swimming or aquatic instructor will be in charge of the water
2.    Child Name:____________________________ DoB ___ /____ /______                          activities. In relation to the proposed water or swimming activities, I advise that my child is a strong, competent
                                                                                             swimmer. Privacy Declaration: I understand and accept that Planetshakers may collect and use information
      Does your child have any medical concerns or allergies?              Yes       No      about me for the purpose of providing and offering promotional material and may provide the information to any
                                                                                             third party who helps Planetshakers provide services to you. I consent to my personal details being used for the
                                                                                             promotion of future Planetshakers events and products. Further details of Planetshakers Privacy Policy can be
      Please note any medical conditions or allergies:                                       found on our website Media Waiver: The conference experience will be captured in
                                                                                             photographs, video and audio. Planetshakers reserves the right to use the material for promotional purposes. I
      __________________________________________________________                             understand it is a condition of all registrant’s entry into the conference that all claims are waived in relation to
                                                                                             inclusion of their likeness in such films or recordings. If I am a parent/guardian I give my consent for my child to
3.    Child Name:____________________________ DoB ___ /____ /______                          be captured on photographic, video and audio media.

      Does your child have any medical concerns or allergies?              Yes       No      STEP 9 – ACKNOWLEDGEMENT & SIGNATURE
                                                                                             In signing I acknowledge the registration information is true and correct and
      Please note any medical conditions or allergies:
                                                                                             I have read, understand and agree to the terms and conditions as set above.
                                                                                             Signature: _____________________________________________________

                                                                                             Name: ___________________________________ Date: ___ /____ /______

     This document is to be retained by the youth group leader as a record of consent to attend Planetshakers Conference 2009. Please do not return to Planetshakers  

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