Please Upload or Take a Recent Photo of Yourself *

Firstname *

Date of Birth *

Address *

City *

State *

Postcode *

Lastname *

Gender *

Email *

Phone / Mobile *

Year Baptised *

Your Home Church *

Relationship Status *

Current Occupation / Grade in School *

I support the mission, teachings and evangelism of the Seventh-day Adventist Church. *

I would be interested in attending Music Camp or D'Sozo Camp as a Counsellor *

Alternative / Emergency Contact

Name *

Mobile Phone *

Relation to You *

Home Phone

Work Phone

Medical

Tick any medical history that applies to you. All answers will be held in strict confidence.

Other medical history

Allergies

Please provide details of allergies

Do you have private health insurance?

Health Insurance Details

Have you ever been arrested, convicted or investigated for a crime involving drugs, sex or violence? *

Do you hold a current First Aid Certificate?

Do you hold a suitability card for child-related employment? (e.g. Working With Children Check) *

Working With Children Check Number:

Optional Donation $ (to help cover cost)

Please choose the payment method that applies

Please send bank deposits to:

The information I have entered is true and correct to the best of my knowledge. *