2022 CAMPERS Camp Registration
10-14 year olds
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Email *
First name *
Last name *
Age *
Daughter's Mobile number (if applicable)
Parent's Name *
Parent's Mobile *
Home Address
Emergency Contact (name & number) *
Does your daughter have any significant medical history? e.g surgery, injuries, serious illness. Please explain. (if none please write 'None') *
What medication must she take for this? (if applicable)
Does your daughter have any dietary requirements? Please state below. (If none please write 'None') *
Is your daughter confident swimming in water? *
Transport (details will be emailed to you) *
I heard about this camp through...
I hereby consent to images/videos taken from the project that might feature my daughter, to be released for the purposes of media releases, reporting and promotion of the project. *
I hereby consent my daughter to attend this camp and all the information submitted above is valid and true. *
A copy of your responses will be emailed to the address you provided.
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