Type/s of Activity/s (eg. Bushwalking & Swimming) :*

Today's Date*

dd/mm/yyyy

Church Department for which the activity is conducted?*

Pathfinders

Junior Group

Teen Group

Youth Group

Youth Department

Education Department

School

Other (Please Specify below)

Specified Answer for "Other"

Do you have authority from your Church Department/Local Church*

Yes

No

Base/Emergency Contact Name:*This person should notify the Police or agreed emergency personnel if not contacted by this date & time:

dd/mm/yyyy

Time*

Parents or next of kin of party members have been given contact details*

Yes

No

Leaders Name*

First

Last

Relevant Qualifications

Home Number

Work Number

Mobile Number

Email

Adventist Outdoors Identification Number:

Assistant Leaders Name*

First

Last

Relevant Qualifications

Home Number

Work Number

Mobile Number

Email

Adventist Outdoors Identification Number:

Location of Activity*

Date of Activity

dd/mm/yyyy

Area Type*

Private Property

State Forest

National Park

Wilderness

Church Property

Other (Please specify below)

Other

Objective of Activity

Recreational

Pathfinder Class Requirements

Honour Requirements

Educational

Training

Other (Please specify below):

Other:

If training, please indicate level of training being undertaken:

Instructor

Leader

Skills

Other (Please specify below)

Other

Total Number of Participants*

Total number of Adults*

Total number of Children/Youth*

Aged between: (ie. Put youngest child/youth age and oldest child/youth age. Note: Once the age of 18 is reached they are classified as an adult)*

Checklist*

Verification of the insurance required by land manager or other (eg, State Forests, National Parks, etc) has taken place.

Risk Assessment Completed.

Submitters Name

First

Last

Submitters Email

Submitters Address

Address 1

Address 2

City

Province

Postal Code

Country

Phone Number

I declare that the information above is true and accurate to the best of my knowledge: (Type in full name)

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