ABIDE- Camper Registration Form

Name*

First NameLast Name

BoyGirl

Birth Date*

MonthDayYear

Year at School*

School

Church

Address*

Street Address

Street Address Line 2

CityArea

Post code

Camper Email*

example@example.com

Camper Mobile Number*

Area CodePhone Number

Why are you interested in Leadership Development?*

I understand that abide is a Christian Leadership Training, a Personal Character Challenge, and a KVCC Training weekend. This means that I will be asked to go out of my comfort zone, asked to Lead through Servanthood, and be challenged Mentally, Physically, and Spiritually.

Parent/Guardian Information

Name*

First NameLast Name

Home Number

Area CodePhone Number

Mobile Number*

Area CodePhone Number

E-mail*

example@example.com

Name*

First NameLast Name

Mobile Number*

Area CodePhone Number

E-mail*

example@example.com

Emergency Information:

Emergency Contact's Name*

First NameLast Name

Relationship

Phone Number*

Area CodePhone Number

Doctors Name/Medical clinic

Doctors NameMedical Clinic

Does the camper have any food restrictions, allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed any medications If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Kauaeranga Valley Christian Camp during abide camp.

I understand that my child will abide by the camp rules with respect and that the camp reserves the right to send the caper home if a health or disciplinary problem arises – no refund will be given. I agree to pay for any damages incurred by camper.

In exchange for the acceptance of said child’s candidacy by Kauaeranga Valley Christian Camp., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Kauaeranga Valley Christian Camp. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Kauaeranga Valley Christian Camp. including all staff and affiliates, all participants, and, Board of Trustees. I agree to reimburse Kauaeranga Valley Christian
Camp with all such associated costs. We do our best to ensure the safety of each camper through proper instruction and execution. There is a risk of being injured that is inherent in all camp activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

I understand Kauaeranga Valley Christian Camp is obligated to contact Oranga Tamariki if they believe the camper has been abused or is in danger of abuse.

I authorize Kauaeranga Valley Christian Camp to send said camper information about future camps.

Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a certified first aid attendent, of the minor child, in the event of a medical emergency, which in the opinion of the Kauaeranga Valley Christian Camp First Aid responder and Camp Managers, requires immediate attention to submit the child to Hospital Services. I give permission for paracetamol to be administered to my child for minor pain at the discretion of the camp staff as per prescribing instructions.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Name of person picking camper up at the end of camp: *

Full NamePhone/Cell

Name of person picking camper up at end of camp:*

Full NamePhone/Cell

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AGREE THAT THE INFORMATION ABOVE IS TRUE. 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.

Signature

abide -Leadership Camp Registration