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Leuk the Duck
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#DoingItForJarrod
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Tie A Ribbon for Challenge
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Fundraise for Challenge
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Join
Donate
About
About Challenge
What We Do
Leuk the Duck
Who we are
Our Values
Our Board
Our Ambassadors
Key Partners
Membership
About Membership
Become a Challenge Member
Update Member Profile
Member Stories
Programs
Emotional Support
Art Therapy
Massage Therapy
Music Therapy
Parent Support
Practical Support
The Challenge Family Centre
Holiday Accommodation
Hospital Support
Scholarships and Trusts
Social Support
Activity Days
Camps
Playgroup
Ticketing
Fundraising
Our Events
Diamonds
Challenge Ball
Allenby Golf Day / Gala
Our Campaigns
#DoingItForJarrod
A Day in May
Biggest Aussie Pie Night
Lace up for Challenge
Tackling Childhood Cancer
Tie A Ribbon for Challenge
How You Can Help
Fundraise for Challenge
Volunteer
News
Shop
Contact
Donate
Sibling Membership Form
Please note, we require you to submit one form per sibling.
1
2
3
4
Sibling Details
Name
*
First
Last
Nickname
Date of Birth
*
DD slash MM slash YYYY
Age
*
Gender
*
Contact Details
Address
*
Street Address
Suburb
State
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Post Code
Primary Contact Number
*
Family Information
Adult A
Relationship to Child
Full Name
*
First
Last
Gender
*
Contact Number
*
Email
*
Adult 2
Relationship to Child
Full Name
First
Last
Gender
Contact Number
Email
Name of Sibling (Challenge Member / Patient)
*
Sibling Interest and Personal Information
Likes (e.g. cars, concerts, art, etc)
Dislikes
Allergies
Dietary Requirements
Favourite AFL Club
Favourite Celebrities
Favourite Singers and Bands
Favourite Movies and TV Show/s
T-Shirt Size
Other Information
Is there anything else you think we should know?
Some Information to Note
The information provided in this Membership Form and all subsequent Brother/Sister Membership Forms will be stored on a database that resides at the Challenge office. This information remains highly confidential at all times, is viewed ONLY by Challenge Staff and will not at any stage be provided to a third party.
The information provided in this Membership Form and all subsequent Brother/Sister Membership Forms will only be used to invite the applicant and their family to attend Challenge activities and events.
As a Challenge Member, you will receive emails and flyers throughout the year informing you of upcoming events.
All Challenge activities and camps are provided FREE of charge and there are no obligations or commitments associated with becoming a member of Challenge.
If at any time, you wish to have your details updated or removed, please phone the Challenge office: (03) 9329 8474 or email: mail@challenge.org.au
I give permission for photographs taken by Challenge of my child and family members at camps, activity days and in hospital, to possibly appear in the Challenge e-newsletter, or events, in print, on tape or on film.
I give permission for photographs taken of my child and family members to possibly appear on the Challenge website, Facebook site or Challenge Social Media.
Please note, no names will be published online without your consent.
*
I, the legal guardian of the child in which this membership form is for, have read and understood how the information provided in this document is stored and used, and furthermore believe the information provided to be true and accurate at the time of signing.
Signature
*
62813
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