Kids Camp Registration Forms 2018
Sign in 4pm Sunday and sign out 10am Friday Cost: Camper - $230 (includes $10 Canteen), Pit Crew - $110 plus canteen, Leader - $80 plus canteen.
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
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 (home)
This may be land line or mobile number
Your answer
Phone (mobile)
Please provide your mobile number in case we need to contact you in an emergency
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 home phone
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
Required
Payment Method
Will you be paying online, are you entitled to OSCAR, or does this need to be invoiced to an Agency?
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
Required
Submit
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