ignite CAMP'22 Registration - Youth • Glen Waverley Anglican Church

ignite CAMP'22 Registration Form

This CAMP form is a COMPLEMENT document ONLY to the FULL Next Gen registration form. If you haven't filled that in yet, please complete it also.

This version is to assist leaders in case of any medical emergency during the CAMP. It also captures their water ability, & dietary choice for the camp cooking team. Please complete electronically. You will then be sent an email regarding payment instructions.

NOTE: Early Bird (save $30) closes FRI 2nd SEPT.
Transport to & from the camp site is the responsibility of the parent/guardian.

If you would like a copy of your completed form, please email Anthony at a.wheaton@gwac.org.au

This form is to be filled in by a parent or guardian of the participant.

( * Camp Leaders - to also fill in but as the 'Child', & sign on their own behalf )

Child details

First Name

School Grade

Last Name

Gender

Parent or Guardian Details - 1

First Name

Email Address

What is your relationship to the young person

Last name

Mobile Number

Parent or Guardian Details - 2

First Name

relationship to young person

Last name

Phone Number

Safety

We are contracting a water activity for 1 day, involving swimming at Safety Beach. Rash vest/Wet suits will be provided. Some floatation devices too. While this time in the water will be monitored, it is helpful to know your child's confidence & interest in such an activity.

What is their swimming ability?

Are there any custody arrangements regarding your child?

Extra info about custardy arrangements.

Emergency Contact (not a parent)

First Name

Relationship to young person

Are they authorised to collect?

Last Name

Phone number

Medical infomation

Medicare number

Are there any medical conditions that we should be aware of? *

Does your child carry any medication with them?

Please give more details about medical conditions, if necessary.

Tip: Eg. Do they have a management plan?

Please give more details about medications, if necessary.

Who is to administer the young persons medication?

Dietary Requirements

Is your child Anaphylactic? If so, to what?

Special diet options - cont.

No Fructose

No Nuts

No Seeds

No Seafood

Permissions

By checking these boxes below, I acknowledge that:

Permissions:

I consent for photographs and video footage of my child during activities to be used to promote the ministry in a way that does not share their details. My child is also willing for this to take place.

I authorise the leader/s in charge of any activity conducted by GWAC (Glen Waverley Anglican Church) to consent on my behalf, where it is impractical to communicate with me, for my child to receive medical or surgical treatment as may be deemed necessary. I am also responsible for the cost of any medical treatment deemed necessary.

Confirmation:

By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.

Name of Signature:

Date of Signature.