SUMMERCAMP 2012 REGO

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This form needs to be completed by your parent/guardian.

FAMILY DETAILS

SURNAME: *

FIRST NAME (Child 1) *

SCHOOL YEAR IN 2012 (Child 1) *

School *

FIRST NAME (Child 2)

SCHOOL YEAR IN 2012 (Child 2)

FIRST NAME (Child 3)

SCHOOL YEAR IN 2012 (Child 3)

Home Address *

Suburb *

Postcode *

Home Phone *

Parent's Name/s *

Parent's Mobile *

Email *

MEDICAL & SPECIAL REQUIREMENTS

Emergency Contact Names *

Relationship to Camper *

Emergency Contact Number *

Medicare Number *

Special Dietary Requirements

Daily Medication Requirements

How many metres can your child swim? *

PAYMENT DETAILS

We don't want to let money get in the way of people coming on Summercamp. If you are unable to afford camp we are able to arrange:
a) payment plans
b) partial sponsorships
c) full sponsorships
Please contact Dave Miers to make an arrangement.

Camp Fees *

$230 for 1 camper

$420 for 2 campers

$600 for 3 campers

Other:

To help a struggling camper, I'd like to donate:

Total Payment *

Camp Fees + Optional Contribution =

Payment Method *

I will arrange the following payment immediately:

I will do a direct depost into the St Faith's bank account, BSB: 032-192 & A/C No: 860318 (labelled "campSURNAME")

I will send a cheque made out to "St Faith's Anglican Church Narrabeen" to 5-9 Clarke Street, Narrabeen NSW 2101

I have already arranged alternative payment.

PARENTAL PERMISSION

1. I give permission for my child/ren to attend and fully participate in Summercamp 2012.

2. Whilst every precaution will be taken to ensure the good welfare and protection of my child, St Faith’s Anglican Church, their staff, leaders and others acting on their behalf are hereby released from any liability in the event of accident or misfortune, damage or loss that may occur to the campers or their property.

3. In the case of a medical emergency, I hereby give permission to the doctor chosen by the camp directors to secure proper treatment for my child.

4. During the course of the week, I am aware that my child may be captured on photograph or video that may be used by St Faith’s for promotional or historical purposes. Any questions please contact Youth Pastor Dave Miers.

I agree to these terms & conditions *

Optional Comments

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