Encounter Camps Young Adults Spring Retreat
Encounter Camps Young Adults Winter Retreat is a fun weekend of fellowship, learning about leadership and riding dirt bikes.

Age: 17+

Get dropped off at camp with your own bike and gear. We will provide accommodation and full catering while on camp.

August 16 - 18 2019 (arrive Friday from 5pm and leave Sunday 4pm)

Where: Pacific Park Christian Holiday Camp, 1110 Papamoa Beach Road, Papamoa

Cost: $120

Safety: We hold an Adventure Mark safety certification. Participant’s safety is our priority on and off tracks, and their equipment needs to be up to our requirements. Find full list at https://www.youthencounter.co.nz/site_files/11361/upload_files/EC_ParticipantsGearList.pdf?dl=1

Further enquiries: Any further enquires about this camp, please contact the Programme Coordinator on 021 599 702 (Tracey) or tracey@youthencounter.co.nz

Full name *
Your answer
Gender *
Date of birth *
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Phone numbers *
Your answer
Email address *
Your answer
I am bringing a dirt bike? *
Emergency Contacts
Please list two emergency contacts details that we can contact while you are on camp.
Emergency contacts name *
Your answer
Contacts phone number *
Your answer
Medical Details
Please provide the participants medical details so we can provide the best possible care for them during camp.
Do you have any medical conditions? *
If YES, please provide the details of your medical condition
May include asthma, diabetes, epilepsy, depression, migraine, chickenpox, ear infections, heart problems, fainting, dizziness, glandular fever, allergic reactions to insect bites or bee stings, food allergies, allergies or any other.
Your answer
Will you be taking any medication during this event? *
If YES, please provide the details of this medication.
Your answer
When was your last tetanus injection? (leave blank if unknown)
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DD
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YYYY
Please provide any further information that may be helpful for us to know?
Your answer
RISK DISCLAIMER
1. I am aware that dirt bike riding and the other activities offered during the camp will involve an element of risk and the participant participates at their own decision and entirely at their own risk.

2. In the event of sickness or an incident I grant permission for Youth Encounter staff to assist or seek appropriate medical attention for the participant and the first available emergency contact provided will be notified promptly. I will reimburse Youth Encounter with any costs that are not covered by ACC they may incur and any other related expenses.

3. I give permission for the participant to be transported during a camp by Youth Encounter staff and I will not hold the driver or owner of the vehicle responsible for any injury or harm that may occur.

4. I agree that Youth Encounter staff and or land owners will be cleared of all personal liability in the event of an incident or loss of person or property occurring on their land or during the camp.

5. The participant agrees to abide by Youth Encounters regulations set-out and will accept the consequences if this is not adhered to. This may include being removed from the Youth Encounter Camp without any reimbursement.

6. Youth Encounter reserves the right to withdraw a participant from an activity that we believe is likely to endanger themselves or others by their actions. We also reserve the right to cancel any activity if we become concerned for any reason.

7. I agree that photographs or video of the participant as well as identifying stories or quotes about the participant, taken during the camp, may be used for Youth Encounters promotional and social media purposes.

8. I give permission for the participant to attend and participate in the Youth Encounter camp listed on this form and all the information supplied on this form is true and correct and I consent to this information being used for the purpose of running the camp and that I will advise Youth Encounter promptly of any changes.

Participant agreement *
'Participant' is the name of the person registered on this form
Registration Fee
$120 paid before camp commences.
Payment details *
Please note the details below to complete the registration. You will be emailed an invoice after registration. Direct debit - BNZ account 02-0452-0048320-00
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