Studentekamp Inskrywing
Is jy 'n eerstejaar of senior? First year or senior *
Naam / Name: *
Your answer
Van / Surname: *
Your answer
ID: *
Your answer
Geslag / Gender: *
Selfoon Nommer / Cell Number: *
Your answer
Epos Adres / E-mail Address:
Your answer
Mediese Fonds / Medical Aid:
Naam van Mediese Fonds / Medical Aid Name:
Your answer
Mediese Fonds Nommer / Medical Aid Number:
Your answer
Hooflid Naam / Main Member:
Your answer
Hooflid ID / Main Member ID:
Your answer
Lid/Afhanklike Nommer / Dependant Number:
Your answer
Enige Mediese Toestand of Allergie / Medical Conditions or Allergies:
Sê vir ons asseblief of jy enige spesifieke medikasie nodig het of enige allergie het (Bring asseblief eie medikasie waar nodig) / Please indicate any medication required or allergies (please bring own medication)
Your answer
Ouer(s) Naam en Van / Parent(s) Name and Surname: *
Your answer
Ouer(s) Adres / Parent(s) Address:
Your answer
Ouer(s) Epos / Parent(s) E-mail:
Your answer
Kontak Nommer vir noodgeval / Emergency Contact Number: *
Wie kan ons kontak as daar 'n nood geval is (Naam + Nommer) / Who can we contact in case of an emergency (Name + Surname)
Your answer
Wyse van Betaling / Method of payment:
Your answer
Epos asseblief bewyse van betaling / E-mail proof of payment, info@somerstrandgemeente.co.za:
Epos asseblief jou bewys na ons saam met jou naam en van in die subject field / Please mail proof of payment with name and surname in subject field
Your answer
Is daar enige aktiwiteite by die universiteit wat jy tydens die kamp wil bywoon? / Any activities at university that you want to attend during the camp?
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