NSW Leadership Bootcamp 2024

Gender *

Male

Female

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Number *

Country

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T-shirt Size *

XS

S

M

L

XL

2XL

3XL

4XL

Others (please specify)

Is the Boot able to swim? *

Yes

No

Parent / Guardian's Contact Number *

Country

(###)

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Pastor's Contact Number *

Country

(###)

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Primary Emergency Contact Number *

Country

(###)

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Secondary Emergency Contact Number *

Country

(###)

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Contact number of Family Physician *

Country

(###)

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Do you plan to attend the Graduation Ceremony on Friday night and take your Boot(s) home with you? *

Yes

No

NSW Bootcamp Liability Disclaimer *

I agree to the following terms as a participant in the NSW Bootcamp organised by the The Potters House Christian Church Parramatta, (hereby referred to as PHCCP). 1. Disclaimer and Release of Liability The organisers, staff, volunteers, and any affiliated entities of PHCCP are not liable for any injuries, losses, or damages that may occur during participation in the Bootcamp. Participants and their guardians acknowledge that they engage in activities at their own risk and assume full responsibility for their participation. I release PHCCP and its staff from any liability for injuries or damages sustained during the bootcamp. 2. Conduct and Safety Participants are expected to follow all safety guidelines and instructions provided by the Bootcamp staff. Failure to adhere to these rules may result in dismissal from the program without refund. PHCCP is not responsible for any incidents that result from a participant's failure to follow these guidelines. I acknowledge that my failure to comply will result in my dismissal from the program. 3. Medical Disclaimer The Bootcamp provides a variety of physical activities that may involve physical risks. It is the responsibility of the participant and their guardian to ensure that the participant is physically fit and capable of participating in the activities. Any medical conditions or concerns should be disclosed to the PHCCP organisers prior to participation. PHCCP is not responsible for any health issues or medical emergencies that arise. I authorise necessary medical treatment in case of emergency at my own cost. 4. Photography and Publicity Bootcamp staff may take photographs and videos during activities for promotional purposes. By participating in the Bootcamp, participants and their guardians consent to the use of these images and videos in promotional materials and on social media. I grant permission for the use of my image in promotional materials. 5. Personal Property Participants are responsible for their personal belongings. PHCCP is not responsible for any loss, theft, or damage to personal property brought to the camp. All necessary precautions will be taken to keep items declared on arrival or left at the Potters House Parramatta building safe, however PHCCP will not be held responsible for any losses or damages. I accept full responsibility for all my belongings, retained and declared, for the duration of the camp. 6. Parental Consent By enrolling their child in the Bootcamp, parents or guardians acknowledge and accept these terms and conditions. They agree to release and hold harmless PHCCP and its affiliated entities from any and all liability arising out of the participant's involvement in the NSW Bootcamp.

Boot to tick

Parent / Guardian to tick