Inflame Youth Camp 2019
May 10, 2019 4:30 PM - May 11, 2019 4:00 PM
Type
Price
Quantity
Youth Camp ~ Single Ticket
Price
$25.00
Quantity
Youth Camp ~ Family Ticket
Price
$65.00
Quantity
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Youth Camp ~ Single Ticket
0
First Name of Youth
*
Last Name of Youth
*
Youth Email Address
*
Emergency Contact Person's Name
*
Emergency Contact Person's relationship to Youth
*
Emergency Contact Person's phone number
*
All meals are provided - Do you have any allergies or dietary needs?
Medical Conditions
*
Arthritis
Epilepsy
Kidney Disease
High/Low Blood Pressure
Asthma
Diabetes
Bleeding Condition
Heart Disease
None of the above
Other Medical Conditions
Do you suffer from the following drug allergies:
*
Penicillin
Morphia
Codine
None of the above
Are you self medicated or do you need medication assistance? (If yes please leave details)
Do you have any disabilities (please state)
Do you have any fears or phobias? (Please state)
When was your last tetanus injection? NB At 4 years and 12 years of age a Tetanus injection is included in the scheduled immunisation
*
Medicare Number
*
Private Health Care Fund (If applicable)
Please indicate your swimming ability
*
Weak swimmer
Competent swimmer
My youth will attending Saturday sports and I will arrange the transport. If yes, please let us know what time they will be leaving camp.
Confirmation of Parental/Guardian consent: I authorise the leader in charge of the above mentioned group to arrange for my child to receive such first aid and medical treatment, as a trained first aid person may deem necessary.
*
Yes
No
I authorise the use of calling an ambulance if it is judged to be necessary.
*
Yes
No
I accept responsibility for payment of all expenses associated with such treatment
*
Yes
No
I can provide transport for my youth (Write 'yes' or 'no' and please state if you have extra seats available for transporting others)
*
Liability Release: Please read the following statements. By writing your full name in the permission section at the bottom of this form you are agreeing to the following.
I acknowledge that camp activities can be hazardous and that my child/children participates at their own risk.
*
Yes
No
I understand the camp leaders take reasonable steps to provide a safe environment for my child/children and to ensure all equipment supplied by them for any activities is of a reasonable standard.
*
Yes
No
I acknowledge that Christian Life Church Kyogle its staff and volunteers will not be liable for any injury that may be suffered by my child/children, which arises either directly or indirectly from, or in connection with, the Inflame Youth Camp.
*
Yes
No
Or that my child/children may cause to another person, as well as any loss or damage to property, equipment or personal effects belonging to my child/children.
*
Yes
No
Write your full name here to agree to the Liability Release and the Inflame Camp rules stated above on behalf of your child. If you are over 18 years of age, write it on behalf of yourself.
*
Youth Camp ~ Family Ticket
0
First Name of Youth
*
Last Name of Youth
*
Youth Email Address
*
Emergency Contact Person's Name
*
Emergency Contact Person's relationship to Youth
*
Emergency Contact Person's phone number
*
All meals are provided - Do you have any allergies or dietary needs?
Medical Conditions
*
Arthritis
Epilepsy
Kidney Disease
High/Low Blood Pressure
Asthma
Diabetes
Bleeding Condition
Heart Disease
None of the above
Other Medical Conditions
Do you suffer from the following drug allergies:
*
Penicillin
Morphia
Codine
None of the above
Are you self medicated or do you need medication assistance? (If yes please leave details)
Do you have any disabilities (please state)
Do you have any fears or phobias? (Please state)
When was your last tetanus injection? NB At 4 years and 12 years of age a Tetanus injection is included in the scheduled immunisation
*
Medicare Number
*
Private Health Care Fund (If applicable)
Please indicate your swimming ability
*
Weak swimmer
Competent swimmer
My youth will attending Saturday sports and I will arrange the transport. If yes, please let us know what time they will be leaving camp.
Confirmation of Parental/Guardian consent: I authorise the leader in charge of the above mentioned group to arrange for my child to receive such first aid and medical treatment, as a trained first aid person may deem necessary.
*
Yes
No
I authorise the use of calling an ambulance if it is judged to be necessary.
*
Yes
No
I accept responsibility for payment of all expenses associated with such treatment
*
Yes
No
I can provide transport for my youth (Write 'yes' or 'no' and please state if you have extra seats available for transporting others)
*
Liability Release: Please read the following statements. By writing your full name in the permission section at the bottom of this form you are agreeing to the following.
I acknowledge that camp activities can be hazardous and that my child/children participates at their own risk.
*
Yes
No
I understand the camp leaders take reasonable steps to provide a safe environment for my child/children and to ensure all equipment supplied by them for any activities is of a reasonable standard.
*
Yes
No
I acknowledge that Christian Life Church Kyogle its staff and volunteers will not be liable for any injury that may be suffered by my child/children, which arises either directly or indirectly from, or in connection with, the Inflame Youth Camp.
*
Yes
No
Or that my child/children may cause to another person, as well as any loss or damage to property, equipment or personal effects belonging to my child/children.
*
Yes
No
Write your full name here to agree to the Liability Release and the Inflame Camp rules stated above on behalf of your child. If you are over 18 years of age, write it on behalf of yourself.
*