Camp Participant Registration Form

Camp *

Teen weekend retreat: 30th April - 2nd May: 14-17 y/o $222 8-10th July Holidays: 10-12 y/o $285 11-13th July Holidays: 12-14 y/o $285 15-17th July Holidays: 14-17 y/o $285

Participant Information

Name *

First Name Last Name

Preferred name/nickname

Eg. Elizabeth/ Libby

Birth Date *

Month Day Year

Gender *

NB, F, M

Address

Street Address

Street Address Line 2

City State

Zip Code

Postal Address if different from above

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Parent/Guardian Information

Name *

First Name Last Name

Contact Number *

Area Code Phone Number

E-mail *

Emergency Information

Emergency Contact's 1 *

First Name Last Name

Relationship

Phone Number

Area Code Phone Number

Emergency Contact 2 *

First Name Last Name

Relationship *

Phone Number

Area Code Phone Number

Does the Participant have any dietary requirement? If yes, please describe. *

Does the Participant have any allergies, chronic illness, or medical conditions? If yes, please describe. *

Does the Participant require medication of any kind? If yes please complete below *

No Yes

For each Medication please specify: Name, dosage amount, frequency.

Eg. Zyrtec, 1 tablet daily with Breakfast

Does the Participant have any medical illness past/present or medical information that we should be aware of? *

In case of Emergency do we have permission to ring the Doctor/Ambulance? *

Yes No

If yes please provide Doctor Surgery Name and Phone Number.

Informed Consent and Acknowledgement

I understand that by completing the form I agree to the following:

I give permission for the Participant to attend Camp and participate in any and all activities during the selected Camp.

The health information supplied in this document is accurate to the best of my knowledge. I understand that if my Child/Participant presents with any cold/flu like symptons upon arrival/duration of Camp their place at Camp will be forfeitted and will be sent Home.

I understand that transport to/from the camp is my responsibility. If your child will be leaving camp with someone other than yourself please provide this to us in writing; we will provide alternate transport forms at Camper Check-in.

I hereby authorise Camps Tasmania and it’s leaders to make arrangements for/provide medical attention to Participant in an emergency or situation deemed necessary. I hereby give permission for the selected physician selected by Camps Tasmania to hospitalise and/or provide treatment as the physician may deem appropriate. I understand that any and all payment for this is my complete responsibility.

I understand that if I/my child breaks or damages any Camp Equipment or property, breakage/damage fees may occur and I will be responsible for paying them.

I agree that if the participant is acting in an unsafe or unwelcoming behaviour towards other participants or Leaders at Camp they will be sent home and it will be my responsibility to collect them from Camp.

I hereby acknowledge that during my/child’s participation in any and all activities at camp, that certain risks and dangers may occur due to accidents, which include but are not limited to: the hazards of depending on other people, being at various heights, activities in remote facilities without medical facilities, the forces of nature, loss or damage of personal property, physical and/or mental injury, not excluding fatality. I hereby assume all mentioned risks and those which are not specifically foreseeable, and will hold Camps Tasmania, including all it’s staff, Directors, Volunteers, Sponsors and all involved persons harmless free from any and all liability, claims and demands of every kind whatsoever, whether for bodily injury, property damage or otherwise, which may arise from or in connection with the Guest’s participation in any/ activities arranged by Camps Tasmania and associated organisations.

Camper Agreement

I understand that it is my responsibility to notify the leaders of any changes to my health and wellbeing before or during the camp.

To ensure the safety of all at camp I understand there will be a need for rules and I agree to follow and abide by them. 

I am prepared to have fun, participate and have a fantastic week at camp. -I will give respect to all involves at camp: leaders, campers and myself.

To ensure that everyone at camp has the best week they possibly can we operate under a no bullying policy. No form of bullying will be tolerated at camp. We also do not allow any drugs, alcohol or weapons at camp and if found this will be confiscated immediately and it may be arranged for me to leave the premises immediately.

I am ready to have an amazing week at camp and give it my all!

I have read, understood and agreed to the all above. *

Yes No

Photo Consent

I give Camps Tasmania and/or Natalie Dell permission to reproduce the Participants photograph or video footage which may appear in the promotional activities for camp.
The material may be in printed and/or electronic form and may include usage on Facebook and the World Wide Web. I authorise Camps Tasmania and/or Natalie Dell to reproduce the photo/video footage of me without any acknowledgement or entitlement to payment. I agree that the copyright ownership will be held by Camps Tasmania and/or Natalie Dell and if I wish to withdraw my permission it will be my responsibility to contact Natalie in writing.

I have read and agreed to the Photo Consent. *

Yes No

Fee Payment

Please be aware that:

Full Camp payment is due within 30 days from date of registration. Unless in the case that the Camp Program will beginning in under 30 days- fees will be due immediately.
Deposits of $50 are non-refundable.
Cancellation with 30 days to Camp program beginning- 50% of Camp Fees will be refunded.
Cancellation within 2 weeks of Camp program beginning- 25% of Camp Fees refunded.
Cancellation within 7 days of Camp program beginning- no Camp Fees will be refunded.

If there are any issues with Payment please contact the team at Camps Tasmania.

I understand the payment terms above. *

Yes No

To complete this registration form and secure a place at Camp, please pay your non-refundable deposit of $50. An invoice will be sent out after we have recieved the completed registration form.

Would you like to add a signature Camp Tee in 2021 Colour for $25? Payable at Deposit Stage. Size: *

10-youth 12- youth 14- youth Small - adult Medium - adult Large - adult Xtra Large -adult XXtra Large - adult No shirt

How did you hear about Camp? If other. please describe

Friend referral; let us know who in 'other' below! School newsletter Facebook Poster

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. THIS ELECTRONIC SIGNATURE AUTHORISES/AGREES WITH ALL ABOVE FOR THE PARTICIPANT NAMED IN THE FORM.

Signature *

Clear

Name *

First Name Last Name

Today's date *

Camp Registration