Hope 2023 Registrations Indonesian Hope Youth is an activity of the Westminster Presbyterian Church Bull Creek Inc. (WPCBC). The activities include, but are not limited to: Bible studies, games and organised activities. Indonesian Hope Youth is primarily held at WPC Bull Creek, 32 Bull Creek Drive, Bull Creek, WA 6149Please enable JavaScript in your browser to complete this form.Surname *Given Name *Date of Birth *Gender *MaleFemaleSchool Year *School Attending *Home Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryParent/Guardian DetailsParent/Guardian Name *FirstLastFirstLastParent/Guardian Contact Number *Parent/Guardian Email Address *Under 18 Medical Form and Authorisation FormAllergiesDoes the attendee have any allergies? *YesNoSelect any allergies that apply *PenicillinBee stingsBetadinePain relief medicationFood allergiesOtherPlease list food allergies *Please list other allergies *Does the person attending require an adrenalin pen? *YesNoPlease note, if you have anaphyaxis you are required to carry your own epipen.Does the person attending have any serious medical conditions? *YesNoPlease select any serious medical conditions that apply *AsthmaDiabetesOtherPlease list other serious medical conditions *Dos the person attending need to use regular medication? *YesNoPlease list any medication that requires self-administration *Emergency Contact InformationContact person in case of emergency *Relationship to child *Emergency contact number *Alternative contact person in case of emergencyRelationship to childEmergency contact numberConsentsI consent that WPCBC may use photos and/or video footage of my child/ward for the WPCBC website/newsletter/other publications *YesNoI authorise the WPCBC leaders, where it is impractical to communicate with me, to arrange for medical treatment and/or an ambulance for my child/ward as deemed necessary *YesIndemnityI agree that:I will be responsible for any costs incurred on behalf of my child/ward due to a medical emergency, accident or misdemeanor whilst attending Indonesian Hope Youth activitiesI accept all reasonably forseeable risks associated with the Indonesian Hope Youth program, including loss or damage to personal property or personal injury sustained by my child/ward I confirm that this information is correct and understand that failure to disclose changed or new information will be at my own riskName of Parent/Guardian *FirstLastSignature of Parent/Guardian *Clear SignatureDate *EmailSubmit