Page 1 of 2

External Staff – Trust Children Urban Retreat Details

About you

Full name

Mobile number

Email address

Role

Organisation / employer (if applicable) or ABN

Emergency contact

Emergency contact name

Relationship to you

Emergency contact mobile number

Food

Lunch will be provided on the day. Do you have any dietary requirements?

Anything else

Is there anything else you’d like us to know to help you feel comfortable and supported on the day?

Declaration

I confirm the information provided above is accurate.

Untitled checkboxes field