NLC 2009 Online Registration Form For further information regarding the National Leadership Camp please contact: PO Box 104 Killara NSW 2071 NSW phone: (02) 9499 5513 fax: (02) 9499 5053 mobile: 0414 891 736 * required field Nominator Information Nominator * School/organisation Position Phone Email Student Personal Information First Name * Surname Gender Male Female Date of Birth Grade Address Suburb Postcode State Phone Mobile Email Medical Information Medicare No Private Health Fund Member No Family Doctor Family Doctor Phone Any known allergies Penicillin Foods Drugs Details/describe What special care is recommended Prescribed medication being brought to camp Special dietary requirements Vegetarian Vegan Other: Transportation Information Make own way to camp Make own way from camp Name of person dropping off / picking up: NLC Coach to camp   Central Station / Sydney Domestic Airport NLC Coach from camp   Central Station / Sydney Domestic Airport Flight / train / bus details: Payment Information NLC Student Registration is $430 (GST Exempt). This covers accommodation, meals, venue hire, bus transportation from Sydney, resource material and participation in all camp sessions. Registration will not be confirmed until payment is received. Payment Method * Cheque Money order Electronic Funds Transfer (EFT) Payment by Cheque Please make all cheques payable to Rising Generations Ltd and send to PO Box 104, Killara NSW 2071 Payment by EFT Account: Rising Generations Ltd BSB: 082- 080 Account Number: 56 667 9593 Bank: National Australia Reference: NLC- 'Student's Name' Receipt Confirmation #: Conditions Alcohol, smoking and/or illegal drugs are prohibited. Separate male & female accommodation is provided. Separate use of these facilities is a requirement. Any student refusing to comply with the rules of NLC or Collaroy Conference Centre, or exhibiting irresponsible behaviour that endangers the health, safety or welfare of themselves or others will be sent home immediately at their own expense. Any damage to property must be paid for by the individual responsible for the damage. A confirmation package will be sent to all participants upon receipt of completed registration form & payment. Cancellation prior to Friday 5 June 2009 will attract an administration fee of $50. No monies will be refunded for cancellation after 26 June 2009. Registration cannot be confirmed until full payment has been received. Rising Generations may take photos &/or video footage at NLC and use for promotional purposes. Please tick below if you do not wish photo/s or footage of your child/guardian to be used. Do not take footage of my child/guardian Parent/Guardian Consent I have read the above conditions and give permission for my child/guardian to attend the 2009 National Leadership Camp. I acknowledge that the staff and volunteer agents of Rising Generations will take all possible care but can not be held responsible for unforeseen accidents or illness. I give permission for this child to undergo treatment by a medical practitioner or be hospitalised at the discretion of the camp staff should the need arise. If in the event my child's behaviour is deemed by organisers to be inappropriate or compromises the safety and/or health of other participants on the camp, Rising Generations reserves the right to send your child home, at your expense, at the earliest possible time, by the most effective mode of transport. Student Consent I have read the above conditions and agree to abide by the rules set down by the National Leadership Camp organisers. I also promise to follow the instructions of all camp staff and take full responsibility for my own actions.