Leader Application Form
This application form needs to be completed for acceptance on Edmund Rice Camps Dunedin, all information will be kept confidentially and will be held by the Camp Captains during camp.

Email address *
I would like to apply to attend *
Required
First name: *
Your answer
Last name: *
Your answer
Home Address: *
Your answer
Gender *
Your answer
Date of Birth: *
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Contact Phone: *
Your answer
Do you have any qualifications, skills or experience that may be of use on camp
eg;abseiling instructor, can play the guitar
Have you attended an Edmund Rice Camp before? *
New Leaders ONLY - Name of the person that introduced you to ERC
Your answer
If you have not attended ERC before, you need to provide 2 referees, Name, relationship to you and Contact number
Could be a teacher/employer/someone that has known you for a long time that is not a relative, PERSON 1
Your answer
PERSON 2
Your answer
For experienced leaders, would you be interested in helping out in other areas of camp?
You do not have to tick any!
Do you object to your photo being used in the media? *
Can you swim? *
A rough estimate is okay
In case of an emergency contact *
Name
Your answer
*
Phone:
Your answer
*
Relationship to you
Your answer
The following information is required by the Community Funding Agency for statistical purposes and for calculation of funds we are eligible for. All information given is CONFIDENTIAL in accordance with the Privacy Act 1993. Please tick all that apply *
Required
CONFIDENTIAL MEDICAL INFORMATION *
Are you currently taking medication?
If Yes, Please specify name and dosage
Please note : The Camp Coordinator must be aware of all medicines that are taken on camp, prior to leaving for camp. These medicines may be kept in the First Aid Centre or kept by the person.
Your answer
Please tick all that you suffer from
Other, please specify
Your answer
Doctor's Name
Your answer
Doctor's number
Your answer
Do you have allergies to;
What special care is needed?
Please specify
Your answer
Are you able to have Paracetamol? *
Do you have any special dietry requirements? *
Whatever you tick, that is what you will be catered for.
Required
DISCLAIMER: Please do not bring valuable items, including cameras, electronic or musical equipment, or significant sums of money with you on camp. ERC does not accept responsibility for loss, damage or theft (however caused or occurring) to any of your items or moneys. If you bring any items or money you do so at your own risk. *
I authorise the Camp Coordinator, or other staff, in the event of any accident or illness and where it is not possible at the time to obtain my consent, or (if volunteer is under 18 years of age) the consent of a parent/guardian, to obtain any necessary medical assistance or treatment. For this purpose, I authorise the previously listed people to engage any doctors, nursing assistance or hospital facilities or accommodation. I agree to pay all such doctors, nurses or hospital expenses incurred.
Because we deal with young children and are recipients of public funds, we must ask the following: Have you any Criminal convictions to your name? *
Please explain. A conviction does not necessarily preclude your participation, but we need to be aware.
Do you consent to a Police Check - If Yes download the form https://www.police.govt.nz/advice/businesses-and-organisations/vetting/forms-and-guides - (Request and Consent Form - NZ Police vet only) Complete page 2 & 3 only. Once completed email the form to ercdunedin@gmail.com
Your answer
I hereby swear that all of the information that I have provided is true and correct. *
Print your name:
Your answer
*
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