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* 1. First name

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* 2. Surname

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* 3. Organisation

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* 4. Mobile phone number (if you have one while in Australia)

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* 5. Emergency contact details
This is in case of an emergency where we would need to contact your next of kin.

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* 6. Do you have any medical condition that you wish to inform us of in case you become unwell during the MOP11 field trip?

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* 7. If you answered yes to the above, can you please let us know of your medical condition and any key medications you take and will have with you

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* 8. Do you have any allergies?

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* 9. If you have an allergy, please let us know what you are allergic to and whether you have any medications or emergency plans that you will have with you

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* 10. Declaration:

I understand the type of activities we will undertake on the field trip (walking, ferry ride, bus rides, indoor presentations) and confirm that I am not performing activities that are beyond my ability.

I will inform the group leaders if there is any reason that may prevent or restrict me from undertaking any of the activities.

If an incident occurs, I will notify the Group Leader on the day as soon as possible.

I have read and understood the potential risks involved in this activity and agree to abide by and implement control measures to minimise risk to my/our health, safety and wellbeing.

I will listen to all emergency procedure plans shared on the day and agree to abide by these in the event of an emergency.

BirdLife Australia is insured for any officially organised and controlled activities conducted by its constituents. To ensure cover for Participants on official BirdLife Australia events, participants must be seen as acting on BirdLife Australia's behalf and there must be some form of agreement, either written or understood, between BirdLife Australia and the individual.

For participation this can be covered by each Participant agreeing to this OHS declaration form, confirming they have read and understand the potential risks involved in taking part in this activity (the risk assessment document shared) and that they agree to follow all reasonable requests of the group activity leader. 

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