Year 10 Camp Permission Form
This form is for parents / caregivers. Please read the "Year 10 Camp Information Letter" for full information, fill in the details below and give permission for your daughter to attend. Please ensure only one form is completed per student. Locations: Manaia Baptist Camp: 16 McDonald Rd, Taurikura. Jaggers Farm "Beach camp" (Oceans Beach). Transport: Bus leaves WGHS (Gate 3) 9am (be there by 8.45am) Taurikura 2pm (arrives at WGHS approx 3pm) Contact: Ben Smedley (Camp Leader) - 021 435 447 Activities: Kayaking, Abseiling, Tramping, Team challenges / Water Based Activity, Music, Flax work, Fire lighting, Pizza cooking
Email address *
Student Surname *
Your answer
First Name *
Your answer
Student House
Student Whanau Class *
Your answer
Parent/Caregiver Name *
Your answer
Parent/Caregiver Phone Number *
Your answer
Parent/Caregiver Email address *
Your answer
Does your daughter have any dietary requirements? If yes, please explain below. *
Dietary Requiements
Your answer
Does your daughter have any medical conditions? If yes, please explain below. *
Medical conditions - please explain condition, symptoms, severity and treatment / medication carried below: (Please email with any recent updates between now and the camp). (This information will be shared with staff on camp to ensure any conditions can be dealt with appropriately and sensitively).
Your answer
I give consent for my daughter to be given the following medication if required. *
Has your daughter had a tetanus injection in the last 5 years? *
Is your daughter a competent swimmer? (Can swim 100 metres and float unassisted) *
Does your daughter have any behavioural characteristics that you think we need to be aware of? If so, please explain. *
Your answer
How will your daughter get to camp? (The bus leaves school at 9am on day 1 of each camp, arriving at Taurikura (Manaia Baptist camp) approx 9.45am) *
How will your daughter get back to school / home after camp? (The returning bus will leave Taurikura camp at 2pm on day 3 of each camp, arriving at WGHS approx 2.45pm) *
If you answered "Car" to either of the previous questions - please explain the details below (who will be driving etc) - it is expected that all drivers will communicate with staff before leaving with any student. Students will not be able to leave the site earlier than 2pm - unless by prior arrangement.
Your answer
Should my daughter be involved in a serious breach of discipline, I accept that I will be contacted to collect her immediately or she will be sent home at my expense. *
If you want to hire any equipment from WGHS, please list the items below. There is a gold coin donation required per item. No item may be taken away from camp and must be returned in the condition that it was borrowed.
Your answer
I have read the Information and give my daughter permission to attend the Year 10 camp 2019? (please write "Yes" or "No" and include your name or electronic signature if possible). *
Your answer
Please select your payment option: ($85) Direct payment details: A/C WGHS Board of Trustees- 020 492 0354488 00 Please ensure your daughter’s name is noted with the payment along with a reference to the Year 10 camp, so that payment can be allocated. *
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