Youth Rush 2026 (mid-year) – VIC Simple Events

Youth Rush Victoria 2026 (mid year)

First Name

Last Name

Date of Birth:

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

Dietary Requirements

Do you have any allergies? Please provide details with expanded information.

Are you a baptised member of the Seventh day Adventist church?

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:

The following WWCC questions are for those who are 18 or older at the time of the program.

Do you have a Working With Children Check (WWCC)?

Yes

Your WWCC number?

Your WWCC expiry date?

The next question is required for everyone to answer; if you are under 18, your answer must be your Guardian.

Name of ‘Next of kin’

Next of kin/guardian’s mobile

The following ABN & Square questions are only for those who are returning as second-time attendees.

Do you have an ABN?

Yes

Your ABN number?

Do you have a credit card payment processing account such as with Square?

Yes

The remaining questions are for everyone to answer.

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.

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.

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.

Please provide a referee for your application. Your referee should not be a relative. It is normally a Pastor or Church Elder or Youth Leader who knows you well.

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?