CODA Camp 2019 Registration Form
JCA Condover Hall, Church St, Condover, Shrewsbury SY5 7AU
Friday 26th July - Monday 29th July 2019
£220 per child.
Please indicate on the form if you are seeking financial support.

Shortly after you've clicked 'Submit' you will be contacted to let you know if you have a place or not. This will hopefully be within 2-3 days though could be longer. You will be sent a link to pay a £50 deposit per child, please make sure you follow this link. Your child's place will not be secured until deposit payment has been received.

Please note: Deposits are 100% non-refundable.

Also note: There will be a slight change for our younger campers this year. That means our campers must be in Year 3 or above. That means most campers will be 8-17, only the younger children in Year 3 will be aged 7. If children are aged 7 and in Year 2 they will have to wait one extra year!

Email address *
Child's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Child's Gender *
Address *
Your answer
Parent/Guardian Name *
Your answer
Contact Number *
Your answer
GP Name *
Your answer
GP Address *
Your answer
GP Contact Number *
Your answer
Does your child have at least one Deaf parent/guardian? *
Does your child have any Medical Conditions? *
If you answered 'Yes', please advise below
Your answer
Does your child have asthma and need an inhaler?
Does your child have any Emotional, Behavioural or Psychological concerns that we should be aware of? *
If you answered 'Yes' please explain
Your answer
Does your child have additional needs and/or 1:1 support in school? *
If you answered 'Yes', please advise below
Your answer
Is your child currently taking ANY medication? *
If you answered 'Yes' please advise below (Please state all)
Your answer
Does your child suffer from any allergies? *
If you answered 'Yes' please advise below
Your answer
Is there anything your child cannot eat or drink? *
If you answered 'Yes' please advise below
Your answer
Can your child swim one length (25 meters) without help? *
Does your child need armbands? *
How would you like to pay? *
Will you be applying for Financial Support? *
Can you tell us why you are applying for Financial Support?
Your answer
Is there anything else you would like to let us know?
Your answer
CODA UK & Ireland and Camp Staff would like to take photographs/videos of children enjoying the Camp. We will only use these when it is safe and appropriate. CODA UK & Ireland have a Photography/Video Policy which can be shared upon request. *
I give CODA UK & Ireland volunteers permission to administer prescribed medication. In the case of not being able to contact me in an emergency, I give permission to act on my behalf if emergency medical treatment is necessary. *
I agree the above information is correct and can be kept on record for CODA UK & Ireland to use appropriately and safely. I will inform CODA UK & Ireland of any changes. I agree for my child to participate in the Camp and activities. I accept there is risk of injury at camp and will not hold CODA UK & Ireland responsible or liable for any harm or loss that should occur during the course of the Camp. *
Submit
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