Reach Youth Camp Registration Form
Saturday 26th - Tuesday 29th June, 2021, at Quinola Lakes Centre, Malanda.
Email *
Personal Details of Participant
First Name *
Surname *
Address *
High School Name *
Year Level *
Date of Birth *
Parent/Carer: Name *
Parent/Carer: Relationship *
Parent/Carer Contact: Mobile *
Parent/Carer: Email *
Emergency contact (other than parent/carer listed): Name *
Emergency Contact: Relationship *
Emergency Contact: Mobile *
Medical Details
Medicare Number *
Private Health (if applicable)
Is your child taking any medication? Please provide details.
Does your child have any allergies? Please provide details.
Does your child have any special dietary requirements? Please provide details. *
Does your child suffer from any medical conditions we should be aware of? Please provide details. *
I authorise the leaders to administer Paracetamol to my child if deemed necessary *
Swimming Ability: My child can swim 25 metres: *
Limited transport will be available to participants through a bus from Cairns. Please let us know if your child will require transport. Please tick below which statement describes your situation best. *
Payment Details
Cost of camp: $150 per participant (covers food and accommodation). Direct deposit only, please use the name of the participant as reference and email payment details to

Bank: Bendigo Bank Account Name: Reach Youth Ministries Inc. BSB: 633 000 Account Number: 168 388 437 Amount: $150
COVID-19 Safety Measures and Cancellation
Participants who are unwell will not be allowed at the camp and will have their registration fee reimbursed. A full COVID-19 safety plan will be in place for the camp.

In the event that the camp is cancelled up to one week before the 26 June 2021, due to COVID-19 restrictions, Reach will reimburse the full amount to participants.

If participant cancels registration up to a week leading to the camp, a cancellation fee of $50 will be retained to cover catering commitments.
Photo Permission: I give permission for photos of my child to be taken as part of capturing the experience of camp and understand that these photos may be used for promotional purposes. *
Consent and Indemnity
Indemnity: I understand that while every reasonable precaution will be undertaken to ensure the protection of my child, I hereby release Reach Youth Ministries Inc., its leaders and volunteers from any liability in the event of any injury, accident, misfortune, damage or loss of property while present at the Reach Youth Camp. Further, I indemnify Reach, leaders and volunteers from and against all loss, including legal expenses, connected with or arising from any claim or demands in relation to my child's attendance at the Youth Camp including my child leaving the venue without permission.

Medical Treatment Consent: I give permission for Reach Youth Group, its leaders and volunteers to obtain emergency medical, hospital or ambulance assistance and/or treatment for my child at any time considered necessary. I understand that every effort will be made for myself to be notified before instituting such procedures. I acknowledge that I will be liable for any medical, hospital or ambulance expenses incurred in the treatment of my child and I agree to pay these expenses.

Involvement Consent: I give permission for my child to participate in activities he/she may choose while attending the Youth Camp. I understand that for the health and safety of all students, staff and volunteers involved in this camp that my child must behave with respect towards all people, equipment and the environment. I understand that if my child should endanger the health and safety of themselves or others that my child may be excluded from activities.

Privacy Declaration: I understand that Reach Youth Group may collect information about my child for the purpose of preparing for this event, and that Reach will not pass my information on to any other organisation.
I have read and accepted the conditions and I give permission for my child to attend the Reach Youth Camp on the 26th-29th June 2021 at Quinola Lakes Centre, Malanda. (Typing your name below indicates your agreement to these conditions). *
A copy of your responses will be emailed to the address you provided.
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