Camp Global® 2019 – Summer Edition (Malaysia)
Consent and Indemnity Form
Date: 10-12 August 2019
Child's Particulars
Child's Name *
Gender *
Birth Certificate Number *
Date of Birth *
MM
/
DD
/
YYYY
T-Shirt Size *
Address *
Email Address *
Dietary Requirements
Please identify any special dietary needs/allergies/restrictions your child has: *
Special Attention and Medical Conditions
Does your child suffer from any of the following? (Please check all that applies)
(If Applicable) Kindly provide details for any of the above circled condition(s).
Any medical allergies? (Yes / No) *
If yes, please specify:
Any other disabilities or chronic illnesses? (Yes / No) *
If yes, please specify:
Any other medical conditions? (Yes / No) *
If yes, please specify
A current or recent ailment (E.g. flu, recent injuries, hospitalisation) (Yes / No) *
If yes, please specify
Are there siblings joining? *
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