RCC Brisbane Children's Camp
Application form for camp: Saturday 22nd September at 1.00pm to Thursday 27th September at 9.00pm
Email address *
Parent First Name *
Your answer
Parent Surname Name *
Your answer
Mobile# *
Your answer
Child's First Name *
Your answer
Child's Surname Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Gender *
Spirit Filled *
Extension Camp: Thursday 27th - 30th (12 {born 2006} to 17/18 years {at school} ) *
Home Address *
Include state, Post Code & country (if from overseas)
Your answer
Medicare # *
Your answer
About the child *
Does your child have to take any medicine? (If so give details)
Your answer
Is there any food your Child MUST not eat? *
(If so give details)
Your answer
Does your child suffer from any allergies? *
(If so give details)
Your answer
Would your child be limited in any way in taking part in normal activities? *
(If so give details)
Your answer
May your child swim under careful supervision? *
Does your child suffer from accidental bed wetting? *
Any other information you think would help *
Your answer
Parent/Guardian Consent *
I understand that neither the Revival Centres International nor their officers will be responsible for any loss, accident or mishap which may occur while my child is travelling to or from, or while they are taking part in any camp activities. I give those officers authority to arrange any necessary medical treatment should my child suffer an accident or illness. Whilst giving authority I accept that those officers will take all due caution to protect my child from any mishap. I agree that my child will be amendable to instructions given by the officer or Revival Centre church. (Sign Below)
Your answer
Child's Agreement *
I agree that while I am attending the children's camp, I will abide by all the rules, and will behave in a manner that will maintain the good name of Revival Centres International. I will also be careful of other people and their property. I will listen and do this to the best of my ability ( if I don’t, I will miss out on my free time and the activity)
Your answer
Child's Name *
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