Blue Light is introducing a new Loyalty Card for the young people of Queensland who attend our events. They will be issued one branch at a time, and we will advertise here, as well as locally when it is your local Blue Light’s turn.

The card will store important information about your parent/guardian’s contact details, as well as any health info we may need in case of an emergency.

We will also use the card to make prize draws!  Your printed plastic card will be sent to your local branch for collection at the next event.

Information provided in this form will be treated as confidential. Access will be restricted to QBLAI registered Police & Civilian Volunteers, except in cases where harm or loss is likely to occur without disclosure of this information. It is essential that this form is completed fully and all relevant information is supplied.

The purpose of this form is:

• To provide a written source of information about individuals participating in activities provided by the QBLAI, including up to date emergency contact information.
• To provide QBLAI volunteers rapid access to health information should it be needed in case of an accident or otherwise.
• To allow QBLAI State Office to compile statistical data regarding attendance of QBLAI activities throughout the State. No names will be identified for these purposes.
• To allow QBLAI to reward Loyalty Card Holders from time to time, with random prize draws, offers of discounted admissions, and/or other promotions.

Apply Online
Given Name *
Family Name *
Display Name *
EMail
Street Address *
Suburb *
State *	Queensland NSW ACT Victoria Tasmania NT SA WA
Postcode *
Home Phone
Mobile
Birth Date *
Upload Your Photo
Medical Issues *
Guardian and Emergency Contact Details
Guardian Name *
Relationship *
Primary Phone *
Second Phone *
Mobile
Alternate Contact
Full Name
Relationship
Primary Phone
Second Phone
Mobile

Blue Light Activities are 100% drug and alcohol free.

Safety is the highest priority and that behaviour which compromises safety is unacceptable.

Failure to follow instructions may result in exclusion from the activity, and parents/guardians being contacted to collect the participant.

In case of an emergency involving my child, I understand that every effort will be made to contact me. In the event I cannot be reached, I further authorise QBLAI to obtain all necessary medical treatment which may be required by my son/daughter/ward including any anaesthetic or surgical attention which may be prescribed by an appropriately qualified medical practitioner. I acknowledge that the costs of any such treatment shall be my responsibility solely.

I authorise QBLAI to use photos/images of my son/daughter/ ward in any media release, website or promotional materials. No names shall be used to identify any individual in any photo used.