Camper's Name and surname *
Your answer
Camper's Grade *
Camper's age *
Your answer
Camper's gender *
Does the camper have any allergies? Please specify *
Your answer
Parent or guardian's name and surname *
Your answer
Parent's email *
Your answer
Transport *
Transport will leave on Friday from church between 3 - 5pm and will return to church by 2pm on Sunday. Transport cannot be guaranteed. Please help if you can
Contact 1 name and cell phone number (in case of emergencies) *
Your answer
Contact 2 name and cell phone number (in case of emergencies) *
Your answer
Medical Aid fund details for the camper *
Your answer
Medical aid membership number *
Your answer
Primary member of medical aid *
Your answer
Benefit option *
Your answer
Consent in respect of an emergency *
The completed details means that the church has the power to act should your child require any emergency medical procedures during your absence. This also entitles us access to your medical aid or hospital plan should emergency medical care be required.
Indemnity agreement *
I understand that attendance of this event is undertaken at the above mentioned child’s own risk and I / we indemnify, hold blameless and absolve Christ Church Midrand, and any of it’s staff, members and Camp leaders, against all or any claims of whatsoever nature that may arise as a result of my child attending the above mentioned camp. I further request that the leader / s in charge act IN LOCO PARENTIS during this event. I understand that in the case of any illness or accident where medical attention is required, the cost thereof will be my liability. I further allow photos to be taken of the children, provided they are used with discretion.
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