Presbytery Youth Camp 23 - 27 April 2018
The below registration and indemnity form are an important part of ensuring the safety of all young people who come along to "Presbytery Youth Camp 2018". By filling out this form and submitting it you are giving permission for your child/ren to participate fully in the program. You also acknowledge that the nature of activities of this camp will involve group and individual activities which may include but not be limited to: sleeping in dormitories; cooking meals, drama; music; art and craft; bush walking; travel in private vehicles; boating; being towed behind a boat on a ski biscuit; playing games; Bible input stories and discussions from a Christian perspective; personal development exercises; leadership development; faith formation; candle making; camp fires and swimming. Unforeseen and unavoidable risks may occur during these activities despite camp directors and leaders following best practice in risk management planning. You also release the 'Uniting Church in Australia' employees, leaders and representatives from any liability of unintended or unexpected accidents or incidents which might occur during participation in the program. In the event of accident or illness to your child/ren you give permission for those in charge to obtain medical assistance or treatment as may be necessary and to engage any medical professionals, including ambulance and hospital and agree to pay for same. If any incident does occurs please be aware that we will make contact with the emergency contact person you give details for as soon as is practicable following such occurrence.

As most young people have devices which can record photos, video and sound, we cannot fully control how they use their devices on camp. We will name boundaries and expectations around the use of media at camp together with other expectations in the areas of respect, participation, legality and safety. There may also be times when leaders will record campers and activities of the camp, this will be done in a way that models the highest level of integrity and all photos taken will be available for campers and parents to view if they so wish. Recordings taken by leaders may be used for future promotion of Uniting Church camps and for reporting on this camp within church contexts. There is a place later in this electronic form for you to indicate any constraints you or your child/ren may wish around this.

Please tick to acknowledge that you have read and accept the above disclosures, procedures, risks and indemnities in relation to your child/ren attending and participating in this activity of the Uniting Church in Australia, Presbytery of Tasmania. *
Required
To discuss any of the following please contact Camp Directors: Amanda Nicholas 0413 617 469 email lnuca.rev@gmail.com OR Jeff Savage 0429 728 243 email jeff@hobartnorth.ucatas.org Amanda and Jeff each have many years of experience in ministry with young people as well as running camps. Please be assured of a professional approach to safety, relationships, boundaries, programs and faith formation.
Please register as either a Camper or a Leader
REGISTRATION - CHILD DETAILS
Please fill out a separate form for each camper
Camper's Name
First Name *
Your answer
Camper's Preferred Name
Your answer
Last Name *
Your answer
Date of Birth - (day, month, year or month, day, year depending on your computer settings) *
MM
/
DD
/
YYYY
School Year in 2018
Your answer
Camper Email Address
Your answer
REGISTRATION - PARENT OR GUARDIAN
Parent or Guardian Full Name
Your answer
Address (Number and Street) *
Your answer
Suburb/ City *
Your answer
Post Code *
Your answer
Phone Number 1 *
Your answer
Phone Number 2
Your answer
Email Address For Correspondence *
Your answer
EMERGENCY CONTACT DETAILS
Emergency Contact Person 1 Name *
Your answer
Emergency Contact Person 1 Contact Details *
Your answer
Emergency Contact Person 2 Name
Your answer
Emergency Contact Person 2 Contact Details
Your answer
IMPORTANT INFORMATION
Please list any information that we may need to know about your child. For example but not limited to: medical; allergies; special needs; medication; foods they cannot eat; needing to carry an EpiPen; gender dysphoria; anxieties; custody arrangements, or anything else we need to be aware of. (If Nil - please write Nil so we know the question hasn't been missed) *
Your answer
Medicare Number *
Your answer
SWIMMING AND WATER ABILITY
Please list how far your child could reasonable swim without any assistance (keeping in mind that current fitness and practice may be less than past achievements). *
Required
MEDIA AGREEMENT
I understand that my child/ren may be recorded (photo, sound, video) during the course of church programs and/or events. By indicating below, I provide consent for their image to be used in either print, electronic, or video form for the promotional purpose of future church based activities and/or to be used to report back to the congregation some of the ministry activities of the church. You are free at all times to view what is held for these purposes. Please read in conjunction with information given at the top of this form.
Please tick the appropriate box *
Required
SIGNATURE
Please type your name below and the date of entry, as an electronic signature of the person filling in and submitting this form.
Name of person responsible for the above information *
Your answer
Date Completed *
MM
/
DD
/
YYYY
Registrations are at this stage are limited to 30 young people. Once the limit is reach names will be placed on a waiting list and you will be contact to let you know this.
Payment is to be made to the UC Presbytery of Tasmania
BSB 017 042
Account Number 109499044
Please use "Camp" plus your surname as a reference when paying.
Registration closes Monday 16 April 2018. Payments are due when registrations close.
*
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