Kids Camp Registration Form April 2019
Sign in 4pm Sunday and sign out 10am Sunday- Cost: Camper - $240 (includes $10 Canteen)
THERE IS NO SIGN IN BEFORE 4PM - IF YOU ARRIVE BEFORE THEN YOU WILL BE ASKED TO WAIT!
Untitled Title
Which Camp would you like to register for? *
First Name *
Your answer
Last Name *
Your answer
Gender *
M/F
Date of birth *
MM
/
DD
/
YYYY
Age *
(at the time of camp)
Your answer
Address *
Street Number, Town/city, postcode
Your answer
School *
(or other educational institution)
Your answer
Does the attendee have any allergies and medical issues? *
i.e peanut allergy, heart condition
Your answer
Does the attendee have any special dietary requirements? *
ie. gluten free, vegetarian. We do not not cater for complex dietary requirements.
Your answer
Please specify any medication that the attendee will need to take during camp *
include name of medication, regularity of use and conditions for use if relevant
Your answer
Specify any conditions, disabilities or behaviours the attendee has that may require special care? *
Your answer
Is the attendee allowed to be given paracetamol or ibuprofen in recommended doses if required? *
Name of parent or guardian *
full name please
Your answer
Parents email address *
Your answer
Phone (mobile) *
This may be land line or mobile number
Your answer
Phone (work)
If applicable
Your answer
Emergency contact name *
(MUST NOT BE PARENT OR CAREGIVER) should we be unable to contact you in the unlikely event of an emergency
Your answer
Emergency contact relationship to attendee *
Your answer
Emergency contact email *
Your answer
Emergency contact mobile phone *
Your answer
Emergency contact work phone *
Your answer
Do you consent to the attendee receiving follow up information from Lakes Ranch *
ie. registration forms for future camps, study materials
Is there anyone who is not legally allowed to access the attendee? *
If yes please provide the name and the relationship of the named person to the attendee
Your answer
Is/are there any other camper/s that you would like to be placed in a cabin with?
If yes please provide names below, we cannot guarantee that they will be together, however we will try
Your answer
Does the attendee have any other needs that we may need to consider?
If yes please specify in the space below
Your answer
Is your child receiving support from any of the following agencies?
Check as many as relevant
Payment Method *
Will you be paying online, are you entitled to OSCAR, or does this need to be invoiced to an Agency? A $100 deposit is required to secure your child's place at camp. The only exceptions are Agency Invoiced registrations.
Who will pick up the attendee from camp? *
If this person changes, you must inform us - the camper will not be released from the camp to any person whose identity can not be verified.
Your answer
Declaration by Parent/Caregivers *
1. I consent to all information supplied on this form being used for the purpose of running the camps and agree that my child will abide by the camp rules. 2. In the event of sickness or accident I authorise that qualified medical attention be secured and notification followed by any expenses sent to me at the above address. 3. I agree that the staff and Leaders will be clear of all liability in the event of any injury or loss which the camper may sustain to person or property. I also agree to pay for any damage incurred by my child to any Lakes Ranch property, by either accident or malicious intent. 4. I consent to photos and video being taken at camp for promotional and advertising purposes. 5. I acknowledge that the $100 deposit is non refundable.
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