Easter Boys Camp 2022

EASTER BOYS CAMP
Registration Details
Parent/Guardian Information
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

Suburb

Post Code
Phone Number *
Mobile
E-mail *
Does your child(ren) require transport? *

Yes No
Please select the desired pick up and drop off point for your child

Duncraig Christan Community Church - 4.00pm (41 Beddi Rd Duncraig) Bullcreek Westminster Presbyterian Church - 5.00pm (cnr bull creek drive and Fyfe circle in the church carpark)
Emergency Information
Emergency Contact's Name 1 *

First Name Last Name
Relationship *
Phone Number
Mobile
Emergency Contact's Name 2 *

First Name Last Name
Relationship *
Phone Number
Mobile
Child Details

1st Child
Full Name *

First Name Last Name
Birth Date *

Month Day Year
Medicare Number *
Position on Card *
Do you have ambulance cover? *

Yes No
Does your Child have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Do you have Ancillary Cover *

Yes No
Does your child require medication *

Yes No
If Yes, please specify
Does your child have any special requirements? If yes, please specify
Boys are put in age appropriate dorms, please let us know if there are any other specific requirements we need to be aware of.
What is your child's swimming on capability
Date of last tetanus

Month Day Year
Date
Any relevant medical history
Any other condition which could be relevant
Child Details

2nd Child
Full Name

First Name Last Name
Birth Date

Month Day Year
Medicare Number
Position on Card
Do you have ambulance cover?

Yes No
Do you have Ancillary Cover

Yes No
Does your Child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Does your child require medication

Yes No
If Yes, please specify
Does your child have any special requirements? If yes, please specify
What is your child's swimming on capability
Date of last tetanus

Month Day Year
Date
Any relevant medical history
Does your child have any special requirements? If yes, please specify
Boys are put in age appropriate dorms, please let us know if there are any other specific requirements we need to be aware of.
Child Details

3rd Child
Full Name

First Name Last Name
Birth Date

Month Day Year
Medicare Number
Position on Card
Do you have ambulance cover?

Yes No
Does your Child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Do you have Ancillary Cover

Yes No
Does your child require medication

Yes No
If Yes, please specify
Does your child have any special requirements? If yes, please specify
What is your child's swimming on capability
Date of last tetanus

Month Day Year
Date
Any relevant medical history
Does your child have any special requirements? If yes, please specify
Boys are put in age appropriate dorms, please let us know if there are any other specific requirements we need to be aware of.
Informed Consent and Acknowledgement

I give permission for my son to attend Easter Boys Camp from Thursday 14th April to Monday 18th April 2021. All care will be taken, Duncraig Christian Community Church and Boys Camp leaders request campers to adhere to leaders instructions for their own safety.

COVID 19

I agree to have a RAT test performed for my child at the drop off point before my child travels to camp. In the interest of safety and to ensure everyone on the camp is kept safe, all children will need to produce a negative RAT before coming to camp. This will be administered at the drop off points by parents whilst being supervised by a camp leader before entering the bus or camp grounds. I agree to supply a RAT test for my child at drop off/prior to entering the camp grounds.
Medical Release and Authorization

I authorise in an emergency, the designated first aider to arrange any medical or dental treatment required, and to authorise the giving of an anaesthetis (general or local). In an emergency I give permission for the designated first aider to call an ambulance. I authorise the designated first aider to administer over the counter medication to my child as deemed necessary.
Payment Details

1 Child registration $ 140.00 AUD

2 Child registration (same family) $ 220.00 AUD

3 children or more (same family) $ 330.00 AUD

Enter coupon

Total $ 0.00 AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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.

IF YOU ARE REGISTERING MORE THAN ONE CHILD, BY SIGNING BELOW YOU ARE SIGNING AS PARENT/GUARDIAN OF ALL CHILDREN IN THE ABOVE REGISTRATION FORM.
*

I agree to be contactable and available to pick my child(ren) up should they become infected with COVID 19 any time during the camp, and within 4 hours of being notified or the next morning should it be after 6pm.
Parent/Guardian Signature *

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EASTER BOYS CAMP

Parent/Guardian Information

Emergency Information

Child Details

Child Details

Child Details

Payment Details