2025 Wentworth Falls Bushwalk Registration • St. John's Anglican Cathedral, Parramatta

First Name *

Last Name *

Mobile Number *

Email Address

Congregation *

Emergency contact first name *

Emergency contact surname *

Emergency contact relationship to you *

Emergency contact mobile number *

Are you bringing any children or youth? *

Yes

No

Please list their names and ages *

Are they able to walk the full distance unassisted? *

Yes

No

How are you getting to/from Conservation Hut? *

I am driving

I am travelling with someone else

Who is driving you to/from Conservation Hut? *

Do you have any medical conditions we should be aware of? *

Tip: (eg. asthma, allergies, etc)

Any medications you'll be carrying or might require during the walk? *

I acknowledge this walk requires a good level of fitness, and I am responsible for my own safety and preparedness. *

Yes

No

I understand that I am responsible for my child/ren's supervision, safety, and wellbeing throughout the day. *

Yes

No