Wahoo! You're coming on the roadie! We are so excited.

We just need a couple of things from you before we shut the mini-bus door!

Whether you are a leader or a youth, please fill out the form below ASAP!

Name

First Name

Last Name

Email Address

Date of birth

YYYY

Home adress

Emergency contact name

Emergency contact phone number 1

Emergency contact phone number 2

Dietary Requirements

Medical conditions or Medications

Medicare number

Private health provider and number

WWCC nunber

If you are leading please pop your Working with children check number

Waiver

I agree to the above terms

I am a legal guardian of the above youth / I am over 18

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Roadie Form