Plantout 2009 July 18th & 19th

Online Volunteer Registration Form
Unless you are a member of the same family, please complete a separate form
Information used only for the purposes of Plantout and subject to the Privacy Act

* Mandatory Fields
First Name:* Last Name:*
Phone:* Email:*
Address:
Town Postcode:
   
Would you like to receive the Project Platypus quarterly newsletter? Yes / No
   
Names of all persons attending Project Platypus 2009 Plantout (All children under the age of 14 must be directly supervised by their parents/carer.)
Name Pre existing injuries or medical conditions
     
I/We will attend All Weekend  / Saturday only  / Sunday only
I/We will be camping Overnight Friday   / Overnight Saturday
Meals Required Saturday lunch  / Saturday evening  / Sunday breakfast  / Sunday lunch
How many Project Platypus Plantouts have you attended?
   
Emergency Contact  
Name:*
Phone (option1)* Phone (option2)*
Relationship to you*
   

Conditions of participation:
 I/We understand the following terms that refer to participation in Plantout 2009:

  1. I/We have notified Project Management of all relevant medical conditions and pre-existing injuries and will assist them to determine suitable activities.
  2. I/We consent to suitably qualified and trained First Aid representatives authorising treatment as necessary and accept responsibility for associated expenses.
  3. I/We understand photos may be taken for us and used for promotion of the event or that I/we will notify the photographer otherwise on the day.
Sign (your name)*
   
* Mandatory Fields