STUDENT APPLICATION FORM

Which Voyage would you like to apply for?

April 2022 (dates & times)

September 2022 (dates & times)

Personal Details

Full Legal Name(Required)

First Last

Date of Birth(Required)

Age(Required)

Gender(Required)

Male

Female

Other

Address(Required)

Street Address Address Line 2 City State Post Code

Photo(Required)

Please upload a 'smiling - head and shoulders' photo of yourself.

Accepted file types: jpg, jpeg, png, Max. file size: 1 MB.

Contact Information

Email(Required)

Home Phone

Mobile(Required)

School Attended

Name of school or other educational institution

Required if attending

Did your school recommend you?

Yes

Name the other group that recommended you

Phone Number(Required)

Email Address(Required)

Parent or Legal Guardian Details

Parent / Guardian Name(Required)

First Last

Relationship(Required)

Father

Mother

Legal Guardian

Address(Required)

Street Address Address Line 2 City State Post Code

Email Address(Required)

Mobile Phone(Required)

Home Phone

Work Phone

Sponsoring Rotary Club(s) if known

Have you made contact with a Rotary Club?

Club Name

District Number

Name of Contact in Club

Mobile

Home Phone

Work Phone

Is there a second club sharing sponsorship?

Yes

Club Name

District Number

Name of Contact in Club

Mobile

Home Phone

Work Phone

Handwritten Document

When you have submitted this online form, you will receive an email with an attachment with which you are required - in your own handwriting (around 100 words) tell us why you would like to be selected to join the Rotary Youth Sailing Challenge on the tall ship STV One & All. When completed, please scan this handwritten document and email to applications@youthsailing.com.au

Medical Information

Medical information required on this form and stored in our secure database will only be disclosed to those people who need to know for the applicant's welfare while on the voyage. Under these conditions, I agree to provide all of the information required below in the Medical Information section.

Consent(Required)

I agree to the privacy policy

I agree to the for storage and use of Medical Information, and agree to provide all of the information required below in the Medical Information section.

Consent given by(Required)

Applicant (If over 18)

Parent or Guardian

Applicant's Name(Required)

First Last

Date of Birth(Required)

Age(Required)

Gender

Male

Female

Other

Address(Required)

Street Address Address Line 2 City State Post Code

Email Address(Required)

Mobile Contact(Required)

Concent - Parent or Guardian's Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State Post Code

Email(Required)

Phone(Required)

Relationship(Required)

Parent or legal guardian’s details for us in an emergency

Name(Required)

First Last

Relationship(Required)

Father

Mother

Legal Guardian

Phone Number(Required)

Email Address(Required)

Relationship(Required)

Alternative Emergency Contact

Name(Required)

First Last

Phone Number(Required)

Email Address(Required)

Tee Shirt Size(Required)

Personal Details

Contact Information

School Attended

Parent or Legal Guardian Details

Sponsoring Rotary Club(s) if known

Handwritten Document

Medical Information

Parent or legal guardian’s details for us in an emergency

Alternative Emergency Contact

Medical Information

For certain medical conditions, we may need to contact your doctor.

Medical Review

Indemnity Acknowledgement

Please note if all applicable items on the form are not completed, and correct additional documents are not uploaded, your application will be rejected.

When you have completed this form, please check your email for a confirmation copy to be sent to you