TeenStreet QLD Application Form


Application Form Step 1

For more information and pricing details click here

We’re looking forward to seeing you at TeenStreet Queensland 2012! There are some simple steps to get you registered. Please fill out the form below and click NEXT.

If you have any queries at all about registration, please contact us!
See you at TeenStreet!

Personal Details

info Please enter your full name here

If you would like a different name on your badge, please enter this in the 'Name on Badge' field.

First Name Field Information

info Please enter your full name here

If you would like a different name on your badge, please enter this in the 'Name on Badge' field.
info If you would like a different name on your badge to what you have entered above, please enter this here.

If you just want your normal name on your badge as above, then leave this blank.

Name on Badge Field Information

info If you would like a different name on your badge to what you have entered above, please enter this here.

If you just want your normal name on your badge as above, then leave this blank.
                    
Teens (age 13-18) Service Team (over 18) Coach (over 21)
M&M (experienced leader) Child (< 13. Child of a leader) Infant (<2)

I would like to come as Field Information

Teens (age 13-18) Service Team (over 18) Coach (over 21)
M&M (experienced leader) Child (< 13. Child of a leader) Infant (<2)

 

If you have multiple family members coming to TeenStreet, we offer a family discount. Please tick this box if you would like to apply for this discount.

Other Information Field Information

If you have multiple family members coming to TeenStreet, we offer a family discount. Please tick this box if you would like to apply for this discount.
/ / DD/MM/YY
Between year 7 to year 12

School Grade Field Information

Between year 7 to year 12
     

Church Contact Details

info Which church do you normally attend?

We are asking this to help work out NET groups at TeenStreet and also so we can contact your church to arrange a group coming together

Church Name Field Information

info Which church do you normally attend?

We are asking this to help work out NET groups at TeenStreet and also so we can contact your church to arrange a group coming together
info Please enter the name of a pastor or leader in the church that we could contact in regards to you coming to TeenStreet.

We are asking this to help work out NET groups at TeenStreet and also so we can contact your church to arrange a group coming together

Church Contact Field Information

info Please enter the name of a pastor or leader in the church that we could contact in regards to you coming to TeenStreet.

We are asking this to help work out NET groups at TeenStreet and also so we can contact your church to arrange a group coming together

Parent / Guardian Details

info If you are coming as a teen (or child) we will need to contact your parents/guardians for their consent to you coming to TeenStreet.

Parent / Guardian Name Field Information

info If you are coming as a teen (or child) we will need to contact your parents/guardians for their consent to you coming to TeenStreet.

Emergency Contact Details

info Please enter the details for someone we can contact during TeenStreet in case of an emergency. This should be someone that is not at TeenStreet with you.

If these details are the same as you have already entered in the 'Parent/Guardian' section, then you can leave this blank. If your parents will be away or out of contact during TeenStreet, then please supply details of somebody else we can contact. The 'Parent / Guardian' section will not show up if you have selected 'Coach', 'M&M' or 'Service Team' above.

Contact Name Field Information

info Please enter the details for someone we can contact during TeenStreet in case of an emergency. This should be someone that is not at TeenStreet with you.

If these details are the same as you have already entered in the 'Parent/Guardian' section, then you can leave this blank. If your parents will be away or out of contact during TeenStreet, then please supply details of somebody else we can contact. The 'Parent / Guardian' section will not show up if you have selected 'Coach', 'M&M' or 'Service Team' above.

Medical & Health Details

if applicable

Private Health Fund Field Information

if applicable

 

info How many years since your last tetanus shot?

If you are not sure, and you think it may have been more than 4 years, please leave this blank, and the checkbox above

Years since immunisation Field Information

info How many years since your last tetanus shot?

If you are not sure, and you think it may have been more than 4 years, please leave this blank, and the checkbox above

 

 

 

 

 

 

Are you subject to asthma, fainting, epilepsy, diabetes or any other condition that may affect your safety during TeenStreet? (We cannot take responsibility for conditions we don’t know about.) Please check appropriate boxes above, and fill in as much detail as possible in the field below

Medical Conditions Field Information

Are you subject to asthma, fainting, epilepsy, diabetes or any other condition that may affect your safety during TeenStreet? (We cannot take responsibility for conditions we don’t know about.) Please check appropriate boxes above, and fill in as much detail as possible in the field below
info If you have ticked any of the 'Medical Conditions' boxes above, please provide as much detail as you can here

If there is anything at all (even if it is not covered by the tick boxes above) that you think may impact your health or safety at TeenStreet, or anything regarding your health that you think may be helpful for our doctor to know, please provide as much information as possible here.

Condition Details Field Information

info If you have ticked any of the 'Medical Conditions' boxes above, please provide as much detail as you can here

If there is anything at all (even if it is not covered by the tick boxes above) that you think may impact your health or safety at TeenStreet, or anything regarding your health that you think may be helpful for our doctor to know, please provide as much information as possible here.

 

 

Travel & Other Details

 

 

 

TeenStreet is planning on making a bus available for those needing transport from Brisbane or Toowoomba. The proposed pick-up points are: Brisbane North (City North Baptist Church), Brisbane South (Oxley), Withcott and Toowoomba.

Travel Information Field Information

TeenStreet is planning on making a bus available for those needing transport from Brisbane or Toowoomba. The proposed pick-up points are: Brisbane North (City North Baptist Church), Brisbane South (Oxley), Withcott and Toowoomba.
info If there is anything else you would like to tell us, please enter that here.

This is also the place to write anything that a TeenStreet staff member has asked you to note on your application such as a special price, or anything that will affect your application process

Maybe you just want to tell us how much you are looking forward to TeenStreet ;-)

Other information Field Information

info If there is anything else you would like to tell us, please enter that here.

This is also the place to write anything that a TeenStreet staff member has asked you to note on your application such as a special price, or anything that will affect your application process

Maybe you just want to tell us how much you are looking forward to TeenStreet ;-)
           
info At this stage we don't have the facilities to process payments automatically.

Electronic Bank Transfer

If you select this, we will send you OM Australia's Bank Details so you can transfer the fees through your internet banking at your leisure. The information we send you will also contain your TeenStreet ID, which will let us know that the payment is for you. This way you can also pay for multiple people in one go.

Payment by Cheque

If you choose to pay by cheque, we will send you all the details you need to send a cheque to OM Australia when you are ready. The information we send you will also contain your TeenStreet ID, which you can write on the back of the cheque so we know that the payment is for you. This way you can also pay for multiple people in one go.

Payment by Credit Card

If you choose to pay by Credit Card, we will send you a payment form to be printed and emailed or posted back.

Payment by Cash

We would prefer that you don't use this method of payment. If this is the only way that works for you, or if you have pre-arranged it with one of the TeenStreet team, then choose 'Cash'. We will send you the details you need to get the finances to us safely.

Payment Method Field Information

info At this stage we don't have the facilities to process payments automatically.

Electronic Bank Transfer

If you select this, we will send you OM Australia's Bank Details so you can transfer the fees through your internet banking at your leisure. The information we send you will also contain your TeenStreet ID, which will let us know that the payment is for you. This way you can also pay for multiple people in one go.

Payment by Cheque

If you choose to pay by cheque, we will send you all the details you need to send a cheque to OM Australia when you are ready. The information we send you will also contain your TeenStreet ID, which you can write on the back of the cheque so we know that the payment is for you. This way you can also pay for multiple people in one go.

Payment by Credit Card

If you choose to pay by Credit Card, we will send you a payment form to be printed and emailed or posted back.

Payment by Cash

We would prefer that you don't use this method of payment. If this is the only way that works for you, or if you have pre-arranged it with one of the TeenStreet team, then choose 'Cash'. We will send you the details you need to get the finances to us safely.
Scan and upload a scanned consent / payment form to this field to keep for your records

Signed Consent Form Field Information

Scan and upload a scanned consent / payment form to this field to keep for your records