Going Further 2018 Registration
By filling in this form, an invoice will be sent to you within a few weeks. Payment can then be made by bank deposit or cheque. Payment must be received no later than 31 Jan 2018
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Name *
Gender *
Age *
Mobile Number *
Email Address *
Church *
Who should we invoice for this event?
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Dietary Requirements
Emergency Contact Info
Who do we contact if there is an emergency
Billing Address
Name and Address *
If you would be willing to assist with corporate worship, tell us what instrument you could bring and play or what other ways you could contribute to worship i.e dance spoken word poet three art etc.
Medical History
As we will be in an isolated environment for several days it is very important that you provide us with any medical information that we may need to know to look after you. Please fill in this section to the best of your ability. Your medical history will be kept confidential.
Please detail if you are currently under medical care for any conditions
Please detail any operations or serious injuries in the past 2 years
Please detail any chronic or recurring illness or medical condition
Please detail any special health and behaviour considerations
Health History
Please tick all that apply
Please give any relevant details about the item you have checked, i.e medication required etc
Allergies
(food, drugs, plants, insects)
Please give any relevant details about the item you have checked, i.e medication required etc
RECOMMENDATIONS & RESTRICTIONS WHILE AT CAMP
.
Any treatment to be continued at camp
Any medication to be administered at camp (must be in original containers with specific dosages)
Any medically prescribed meal plan or dietary restrictions
Additional Health Information / Activities to be limited
AUTHORISATION
.
*
Required
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