JUNIOR HORSE CAMP
Which camp will your child be attending? *
First Name *
Your answer
Last Name *
Your answer
Gender
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Address *
Street Number
Your answer
Address *
Street Name
Your answer
Address *
Suburb
Your answer
Address *
Town/City
Your answer
Address *
Postcode
Your answer
Parent/Guardian *
Name
Your answer
Parent/Guardian *
Home Phone Number- Please include area code
Your answer
Parent/Guardian *
Work Phone Number
Your answer
Parent/Guardian *
Mobile Phone Number
Your answer
Parent/Guardian *
Email Address
Your answer
Emergency Contact Name *
Please provide details for a person we can contact should we not be able to contact you in the event of an emergency. We will require the contact's name, phone number, mobile number (if available) and their relationship to the child.
Your answer
Emergency Contact *
Home Phone Number- Please include area code
Your answer
Emergency Contact *
Mobile Phone Number
Your answer
Any allergies your child has
ie. Food, Animal or Plant allergies
Your answer
Any Medical conditions your child has
ie. Asthma, Diabetes
Your answer
Any disabilities or behavioral conditions - please explain
Your answer
Any medication your child needs during camp
Note: all medication including panadol and antihistamines will need to be handed in
Your answer
Permission for Lakes Ranch to administer paracetamol, panadol or ibuprofen? *
Lakes Ranch may provide these medications if necessary for the comfort of your child
Does your child have any other needs we should be aware of?
Please specify
Your answer
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