Ignite Summer Camp, Wanaka & Queenstown, 6-8th December 2019
Ignite is heading down to the sunny central Otago for a weekend of water, sun and heaps of fun! This camp is for anyone from Year 8 to 13.

Please complete the form below for each individual camper. Required fields are marked *

The $90-00 camp fee includes transport, food and accommodation. Camp fees can be paid by cash, cheque or via internet banking using the following details:

Cheques can be made out to ICBC, or you can make a direct deposit into the ICBC bank account. The Account number is: ANZ 06 0925 0167179 00. Please put ‘Summer Camp’ and your child's name as the reference. Eftpos facilities are also available after the Sunday Service and before or after youth group events.

***Registrations Close Tuesday 26th November 2019 ***

More info? Contact Jeremy at, 021849909 or youth@icbc.org.nz
Name & Surname *
Your answer
Address *
Your answer
Email *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender *
What year is your child at school? *
Emergency Contact Person #1 *
Your answer
Emergency Contact Number #1 *
Your answer
Emergency Contact Person #2 *
Your answer
Emergency Contact Number #2 *
Your answer
Dietary restrictions *
Does this camper have a moderate level of fitness? *
Can this camper swim 50m? *
Is there anything else we should know to keep this camper safe?
Your answer
I give permission for my son/daughter to attend this event and participate in all activities. This includes 1) being transported by a licensed driver in a warranted vehicle, 2) permission to be taken to medical treatment if required and acknowledge that I will cover associated costs, 3) permission for photographs to be taken to be used by ICBC Youth Ministries and Invercargill Central Baptist Church.I agree to inform my young person that they are responsible for their own behavior and if required, will collect them at once. I acknowledge that there are risks associated with this event and whilst ICBC Youth Ministries/Invercargill Central Baptist Church will do everything to identify and minimise these, it is not possible to remove all risks. *
Required
I have read the information about the Summer Camp which I have applied to attend. I am aware that participation in the programme, in which I have enrolled, could involve certain risks due to the unpredictable forces of nature and environment. I recognise my instructor/leader has the responsibility of managing the safety of any activity I take part in and while I understand that all activities are voluntary, I accept that for my own safety, I will need to follow all instructions given by my instructor. I accept personal responsibility for my own actions and safety and that of others. *
Required
If payment has been made by direct deposit OR Eftpos please give the date of payment
MM
/
DD
/
YYYY
Payment method ($90 per camper) *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy