FORM ID 4738404 BEFORE YOU START This form ... is to register to attend an SU Event and/or to make payment for an activity you are volunteering on. (This is not the form to use if you are signing up as a camp participant.)If you have any problems with the form contact the SU Office.Details of the Scripture Union Privacy Policy can be found here. Unfortunately Registrations have closed for this event. Please visit our website for other available events. Event ID Publish StatusPlease select... In Progress Published Adult Registration Fee Family Registration Fee Contact ID Registration AvailabilityPlease select... Register Waitlist Closed Concession Registration Fee Activity Instance ID Instance ID Filled?Please select... No Yes Concession Registration AvailablePlease select... No Yes Family Registration AvailablePlease select... Yes No Merchandise Available?Please select... Yes No Event specific Questions included?Please select... Yes No Additional Event specific Questions included?Please select... Yes No Update Source For event typePlease select... SU Camp SU School Group (ISCF, SUPA Club) SU Mission (SUFM, SUmmerlife) Other Payment Required?Please select... Yes No Payment in Full requiredPlease select... Yes No VirtualPlease select... Yes No Notification (email) I am signing up for: For event typePlease select... SU Camp SU School Group (ISCF, SUPA Club) SU Mission (SUFM, SUmmerlife) Other Event name SU Activity Name Mission team or SU Camp Event Date and Start time I am interested in signing up for: Event name SU Activity Name Event description Event Date and Start time Contact Details First Name Last Name Date of birth Email Mobile phone Parent / guardian / carer's details Parent / guardian / carer's First Name Parent / guardian / carer's Last Name Email Mobile phone Contact phone during program Site / holiday address Home address Town / suburb State Postcode RSVP Will you be attending the event?Please select... Yes No Participant details This section can be replicated for each person being registered. Registration TypePlease select... Adult Concession AgePlease select... 18+ 16-17 11-15 6-10 1-5 <1 Registration Fee $ Concession Registration Fee $ Family Registration Fee $ On behalf ofPlease select... Myself Accompanying family member under the age of 18 Someone else under the age of 18 First name Last name Year at school (next school term) Email Mobile phone Emergency Contact Name Emergency Contact Mobile phone If applicable Registration Fee $ Registration Quantity Event Specific Questions Question 1 Answer 1 Question 2 Answer 2 Question 3 Answer 3 Additional Event Specific Questions Question 1 Answer 1 Question 2 Answer 2 Question 3 Answer 3 Dietary Requirements Type of AllergyPlease select... Dairy Egg Fish Gluten Lactose Peanut Sesame Shellfish Soy Tree Nuts Wheat Other Other allergy Severity LevelPlease select... Severe/Anaphylactic Significant/Sensitivity Intolerance Minor/Traces acceptable Personal preference Permission and Indemnity I permit my child / children to fully participate in all Scripture Union associated activities. In the case of a medical emergency I give permission to Scripture Union to attain medical assistance for my child / children. I understand that every effort will be made to contact me prior to initiating such. Personal details will remain confidential and will not be provided to others except as may be required by Law. The Scripture Union privacy policy is available on our website www.sunsw.org.au. Total Registration Fee $ Total Registrations Additional Items Merchandise TypePlease select... Resource Promotional Insurance Other Clothing Item Description Size Quantity Price $ Total Total Additional Items Cost $ Payment Summary Have you made, or do you wish to make, an application for Kids to Camp financial assistance? (Exclusions - overseas camps and SUFM)Please select... Yes No Full or Partial Support?Please select... Partial Support Full Support Support Amount Requested $ Would you like to make an additional donation to support this ministry?Please select... Yes No Select the Amount you would like to donate $20 $50 $100 $200 Other Enter the Amount you would like to donate $ Payment Summary Total Number of Registrants Family Member Discount (When registering 3 or more) % Discount Calc Total Registration Cost $ Total Merchandise Cost $ Total Donation $ Total Amount Payable $ Are you currently able to pay for this registration?Please select... Yes No Please enter the Amount you are able to pay for currently $ Remaining Payable in Future $ Payment Information Name on Card Card Number MM YY CVV Billing Email ??Now obsolete?? Charge ID reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA.
