Horse Camp Leader/Wrangler/Helper Registration 2018
This form is for those who have been recognised by the camp director as a leader/wrangler or helper:

Fees are payable to Lakes Ranch Bank Account prior to camp starting to confirm you are available, no cash on the day please. See bank account below. All leaders/helpers/wranglers need to register.

TEEN HORSE CAMP HELPERS DESCRIPTION - ARE YOU A:
* Senior Leader: 16 years +, Christian / Great with kids - RESPONSIBLE for looking after the cabin group.
** Junior Leader: 14 years +, Christian / Great with kids - SUPPORTS Senior Leader in looking after cabin group.
*** Wrangler/Helper: Fabulous Helper with kids and horses (Christian OR Non-christian)

TEEN HORSE CAMP COSTS * Senior Leader (16yrs +) are $100 with own horse / $150 if horse is required.
** Junior Leader (14 yrs +) $200 with own horse / $250 if horse required
*** Wrangler/helper (14 years +) with own horse $250 /$280 If horse is required
*********************************************************************************************************************
JUNIOR HORSE CAMP COSTS: - Leaders/Helpers/Wranglers $50 (13 yrs +)

Thank you, we appreciate your help in making this a wonderful camp for our up and coming riders.

Date of Birth *
MM
/
DD
/
YYYY
Which camp would you like to register for? *
Name *
Your answer
What would you like to register as? *
Age *
Your answer
Email
Leaders email address if they have one
Your answer
Mobile number *
Leaders Number if they have one
Your answer
Gender *
Do you give permission for us to contact you via email and mobile? *
Parent/Guardians Name *
Full name please
Your answer
Address *
No.
Your answer
Address *
Street
Your answer
Address *
Town/Suburb
Your answer
Address *
City
Your answer
Home Phone *
Your answer
Mobile Phone *
Please provide your mobile number in case we need to contact you in an emergency.
Your answer
Work Phone *
if applicable
Your answer
Parents Email *
Your answer
Specify any conditions, disabilities or behaviours the attendee has that may require special care?
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
Does the attendee have any special dietary requirements?
ie. gluten free, vegetarian, peanut allergy
Your answer
Is the attendee allowed to be given paracetamol or ibuprofen in recommended doses if required? *
Do you consent to the attendee receiving followup information from Lakes Ranch? *
ie. registration forms for future camps, study materials.
Emergency Contact Name: *
Please provide the name and phone number of a nominated emergency contact (MUST NOT BE PARENT OR CAREGIVER) should we be unable to contact you in the unlikely event of an emergency. Please also state the nominated person's relationship to the attendee.
Your answer
Emergency Contact Mobile Number: *
Your answer
Emergency Contact Home Number: *
Your answer
Is there anyone who is not legally allowed access to the attendee?
If yes, please provide the name and the relationship of the named person to the attendee.
Your answer
Who will pick up the Leader 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 *
1. I consent to all information supplied on this form being used for the purpose of running the camps and agree that my child will abide by the camp rules. 2. In the event of sickness or accident I authorise that qualified medical attention be secured and notification followed by any expenses sent to me at the above address. 3. I agree that the staff and Leaders will be clear of all liability in the event of any injury or loss which the camper may sustain to person or property. I also agree to pay for any damage incurred by my child to any Lakes Ranch property, by either accident or malicious intent. 4. I consent to photos and video being taken at camp for promotional and advertising purposes.
Payment details *
The attendee's camp fees need to be paid by bank deposit BEFORE CAMP STARTS, this helps us confirm our leaders. TEEN CAMP : Please use the reference SNRLDR Or JNRLDR Or WRGLR, and "Surname" Only use "Lakes Ranch Charitable Trust bank account BNZ 02-0412-0052843-00. Thank you, we look forward to serving with you at camp.
Your answer
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