Easter Junior High Camp 2015 – Female Camper

Camper's details

Only one camper per form...

Name*

First Last

Birth Date*

School grade in 2015*

Current school*

Preferred Roommate(s)

If there are other campers who you would like to be roommates with, please list them here. Unfortunately we can't guarantee roommates, but we will make every effort.

Parent / Guardian details

Parent / guardian name(s)*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone (home)*

Phone (mobile)*

Phone (work)

Email*

Additional emergency contact

Name*

Phone number*

Relationship to camper*

Medical / Safety / Wellbeing information

We would like to assure you that this information is required only so that we can provide your child with the utmost care. The information will be treated as confidential and will in no way affect your child’s acceptance to camp.

Medicare No.*

Position on card*

Please select the number beside the camper's name on the Medicare card.

Expiry date*

Please use the format mm/yyyy

Date of last Tetanus injection

Are there any issues or medical conditions we should be aware of?

For example: Allergies, Anaphylaxis, Asthma, ADD / ADHD, Epilepsy, Diabetes, Sleepwalking, Bed wetting, etc.

Does your child take any medication?

Please ensure all medication is handed to the camp nurse on arrival.

Are there any dietary conditions / restrictions we need to be aware of?

Is there any other social, health or behavioural information that would assist in your child having an enjoyable time at Camp Kedron?

Is there anyone who is legally restricted from seeing the camper?

Photo / Video permission

Do you agree to permit the use of photographs and videos of the applicant camper, in promoting Camp Kedron activities and programs? This may include publishing the photos on the Camp Kedron official website and on the Camp Kedron's official Facebook page.

Yes
No

Booking conditions

I understand that places on Camp Kedron Holiday Camps are limited and that a place cannot be regarded as secured until I have received a confirmation of booking from Camp Kedron. I understand that camp fees are non-refundable once a place has been confirmed. If my child is unable to attend camp due to unforeseen circumstances, I will contact Camp Kedron as soon as possible to enable my child’s place to be made available to others.

Acknowledgement / Authorisation

In registering my child for a Camp Kedron holiday camp I acknowledge and understand that: Whilst at camp everything practicable will be done to ensure the comfort and safety of my child, and whilst due care will be taken by Camp Kedron / United Christian Youth Inc and its leaders and employees, they will not incur responsibility for any accident or sickness, or loss / damage to property, which may occur through any circumstance. Should Camp Kedron staff or leaders consider that my child requires first aid or minor medical treatment (including oral analgesics, anti-inflammatories, antihistamines and wound care), I consent to them providing such treatment with due care. In the event of more significant accident or illness, all practicable effort will be made to communicate with me. If such communication cannot be made, I authorise the Camp Director to consent to my child receiving such medical treatment as deemed appropriate by a treating doctor or paramedic. Camp Kedron does not permit the use of alcohol, non-prescribed drugs and smoking on camp. If, in the opinion of the Camp Director it is deemed necessary for my child to return home due to illness or injury, or due to behaviour deemed unacceptable or inappropriate, I will arrange for my child to be collected as soon as practicable.

Payment

Clicking below will take you through to our secure PayPal page to complete payment. Please note that your online registration will only be submitted if the PayPal credit card payment on the following page is successful.

Fee per camper

Price:

I have read, and agree to, the Booking Conditions and Acknowledgement / Authorisation agreement.

Name

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