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Permission and Medical Release Form

I give permission for my child/youth to participate in the Firle Stake Trek 2021 and authorize those adult leaders supervising this event to administer emergency treatment to the named participant for any accident or illness in approving necessary medical care. This authorisation shall cover this event and including all required transportation to and from Calperum Station, South Australia

The participant is responsible for his/her own conduct and is aware of and agrees to abide by Church standards, trek and Calperum station safety rules and other pertinent instructions. Participants' conduct and interactions should abide by Church standards and exemplify Christlike behavior. 
 

Parental Media Recording Release Form

I consent and agree that for the duration of this event and any associated events and person(s) authorised by the Firle Stake APYW committee to record the event in photographs or video, has the right to take photographs, video tape recordings or digital records of the below named participant. 

I authorize the use of any such recording in any and all media, exclusively for the purpose of promoting Firle Stake Youth activities. 

I understand that there will be no financial or other remuneration for record the below named participant, either for initial or subsequent transmission or play back. 

Register for Adelaide Firle Stake Trek 2021

No Yes

Usually this is a Priesthood Leader or someone who is helping at the event

Female Male
Yes No

Please let us know if your stake in South Australia, Australia is missing. Don't forget that some stakes have official names like "Brisbane Australia Logan Stake" rather than just "Logan Stake". If you are registering outside of the boundaries of the State or Country that this event is taking place in, you may need to just select "Other".

Please let us know if your ward in South Australia, Australia is missing. Before contacting us please 1) try refreshing the page and 2) make sure you have selected a Stake first. Most of the "missing" wards reported turn out to not be missing at all. If you are registering outside of the boundaries of the State or Country that this event is taking place in, you may need to just select "Other".

Contact Details

Emergency Contact Details

Medical Fund Details

Special Requirements

Please do not enter "none" or "n/a". Just leave it blank if you have none.

Please do not enter "none" or "n/a". Just leave it blank if you have none.

Please do not enter "none" or "n/a". Just leave it blank if you have none.

Additional Questions

Please state the full name and ward of anyone nominated

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