FUSE Youth Camp '19 registration
Dates: Friday March 8th to Sunday March 10th 2019
Who: Anyone who will be in school years 9 - 13 in 2019
Earlybird Price: $90 if registered and paid by December 21st
Standard Price: $110 if paid after December 21st
CAMPER DETAILS
Details of the teenager attending.
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
School in 2019 *
Your answer
Year at school in 2019 *
Home address *
Your answer
Details of any allergies, dietary requirements, special needs, behavioural issues or custodial restrictions we need to know about.
Your answer
If medication is required at camp, please list the following below: Name of medication; Dosage; Time to be administered; Health condition it is required for.
Your answer
'BRING A FRIEND' promotion
With so much fun in store we don’t want to keep it all to ourselves – we need to spread the word. So if you bring a friend to FUSE Youth Camp’19 (who hasn’t been to Fuse before) you & your friend each go in the draw to score a FUSE Merch pack (hoodie, t-shirt, beanie & drink bottle) plus every entry will receive a cheeseburger voucher!
If you haven't been to Fuse before and a friend invited you, please write their name below.
Your answer
PARENT/CAREGIVER/EMERGENCY CONTACT 1
The person we should contact first in the event of an emergency
Emergency contact 1 - first name *
Your answer
Emergency contact 1 - surname *
Your answer
Relationship to camper *
Emergency contact 1 - phone number *
Your answer
Emergency contact 1 - email address *
Your answer
PARENT/CAREGIVER/EMERGENCY CONTACT 2
An alternative contact person if we cannot contact the first person
Emergency contact 2 - first name *
Your answer
Emergency contact 2 - surname *
Your answer
Emergency contact 2 - phone number *
Your answer
Relationship to camper *
PARENT/GUARDIAN DECLARATION
I agree and acknowledge that LifeSwitch and Camp Staff have my permission to arrange any necessary urgent medical treatment at my cost. I will notify LifeSwitch of any changes to registration information immediately. I am happy for my child to appear in videos or photos of camp activities that might be used for promotional purposes. I consent to my child being transported to off site activities.
PARENT/GUARDIAN CONSENT *
Required
PARENT/GUARDIAN NAME *
Your answer
EMAIL ADDRESS FOR CONFIRMATION & GEARLIST *
Your answer
PAYMENT
Please deposit $90 into the LifeSwitch Bank Account: 06-0545-0014111-26 by 21 December 2018 to secure the earlybird rate. If paying later than 21 December, the cost will be $110.00. Please use the camper's name and FUSE as references.
If you have any questions contact Youth Pastor Ana Van Elswijk - ana@lifeswitch.org.nz
PRIVACY ACT DECLARATION
The information that you have supplied is necessary for the safe and effective operation of this Camp, and has only been collected for that purpose. You may review information pertaining to your registration at any time.
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