Youth Rush Victoria 2026 (mid year)
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First Name
Last Name
Email
Phone/Mobile
Age
Address
Street No. & Street Name
City
State
Post Code
Our initial plan is that all meals will be vegetarian. Do you require vegan meals?
Yes
No
Dietary Requirements
Do you have any allergies? Please provide details with expanded information.
Are you a baptised member of the Seventh day Adventist church?
– Select –
Yes
No
Which church do you attend most of the time?
Why would you like to attend this program?
Have you had any experience with canvassing/doorknocking? If so, tell us about this experience.
Medicare Number:
Position on Card:
Expiry Date:
Do you have a Working With Children Check (WWCC)?
Yes
No
Your WWCC number?
Your WWCC expiry date?
Name of next of kin (this should be your guardian if you are under 18)
Next of kin/guardian’s mobile
Do you have an ABN?
Yes
No
Your ABN number?
Do you have a credit card payment processing account such as with Square?
Yes
No
If I suffer injury or illness while YOUTH RUSH Conference, the Literature Ministries or the organisation can arrange medical and emergency evacuation services as deemed necessary by the organisation, for my health and safety.
– Select –
I agree
I don’t agree
While at the YOUTH RUSH Conference, I understand that photos and videos of those covered by this registration may be taken and that this event could be live-streamed. I also understand that the photos and video footage may subsequently be used in productions and promotions (including print, internet, social media and audio-visual presentations) by Literature Ministries and the Victorian Conference.
– Select –
I agree
I don’t agree
I understand that my NAME, CONTACT NUMBER, MEDICARE, GENDER, CHURCH NAME and EMERGENCY CONTACT details will be collected and stored securely by Literature Ministries in Victorian Conference and will be held from the point of Registration until six months after the YOUTH RUSH Conference 2026 (mid-year). This data will only be used for the purposes of registration, contact and identification at the YOUTH RUSH and Literature Ministries in Conference and will not be shared with any third parties.
– Select –
I agree
I don’t agree
Referee’s First Name
Referee’s Last Name
Referee’s Position
Referee’s Phone/Mobile
Is there any additional information you would like to add with your registration?
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