YMCA Summer Holiday Camp January 2020

Emergency Contact Details
Please ensure that at least two of the emergency contact details listed are available 24 hours while participants are on camp in the case of an emergency.

It is YMCA South Australia policy to have at least two 24 hour emergency contacts for campers.

Your registration will not be accepted without this information.
Emergency Contact #1 - KEY CONTACT PERSON
Name *

First Name Last Name
Relationship to participant *
Phone number *
Email *
Emergency Contact #2
Name *

First Name Last Name
Relationship to participant *
Phone number *
Email *

On Camp
What does the participant want to get out of a YMCA holiday camp?
Are there any recent or ongoing situations at home that may have some impact on the participant during camp that we should be aware of?
Is there anything special that YMCA Camping leaders can do to ensure the participant has the most enjoyable time on camp?
How will you be getting to and from the camp?
YMCA can provide transport for an additional cost of $25 one way or $40 return.
Self-Drive: Drop off & Pick Up at Openlight Campsite (Victor Harbor) $40 Return transport to and from YMCA Marion Fitness & Leisure Ctr (Marion) $40 Return transport to and from YMCA Parks and Rec Ctr (Angle Park)

Permission & Important Information
Behaviour on camp
If a participant on camp displays behaviour that puts themselves or others at risk, or behaviours that lessen the enjoyment of the camp for others, they will be removed from the group and sent home. Any costs associated with this will be the responsibility of the parent/guardian of the participant and the expectation is that they will be collected from camp within a reasonable time frame.

Terms and Conditions, Refunds and Cancellations:

https://www.sa.ymca.org.au/what-we-do/youth-empowerment/program-terms-faq
Image consent

Activity photos are often taken at camp. I hereby agree that my photograph may be reproduced in print and electronic format for YMCA South Australia for promotional activities. I understand that:
- My photograph/footage may be used more than once in a variety of YMCA SA printed publications relating to; promotional activities, advertising & brochures.
- My photograph/footage may be presented in a variety of formats including digital on social media sites and electronically on the YMCA SA and YMCA SA associated websites.
- My first name and last name may be used in some cases to describe the content of the photograph/footage.
- I will not receive any royalties from YMCA SA for the use of my photograph/footage, either locally or internationally.
- I may contact YMCA SA in writing to request that my photograph no longer be used in future print or electronic media. On request the YMCA SA will cease to use my photograph but may not be able to withdraw all current media (already featuring my photograph) from circulation.
- The YMCA SA will use my photograph/footage respectfully and will not alter it in anyway.
I agree to the above image consent *

Yes No
If there are any conditions to the above consent, please provide details.
On camp we sometimes conduct a short survey to find out what our campers enjoyed, and where we can improve. We use this information to help us make the camp experience even better in the future!
I consent for the participant to be surveyed *

Yes No
By providing an e-signature, I confirm that the information provided in this form is accurate, that I agree to YMCA SA's policies and expectations listed above, and I give permission for the participant to participate in the July Winter Camp 2019 including all activities on site.

Where it is impractical to communicate with me, I authorise the YMCA representative to obtain, at my cost medical/ambulance assistance in the case of accident or emergency that may involve my child.

I agree that the YMCA and its officers, leaders and staff shall be, to the full extent permitted by law, released from and shall not incur any responsibility or liability whatsoever for any accident or injury sustained by my child included on this application or for any damage to or loss of my personal property.

I have read and agree to the YMCA's holiday camping cancellation policy available online at http://www.sa.ymca.org.au/our-services/inspiring-young-people/terms-and-conditions/
Signed by *
Signature (use your cursor to sign your signature) *

Clear
How did you hear about this camp?

YMCA website Facebook I've previously attended YMCA camps Kids in Adelaide Promotion

Should be Empty:

Street Address
Street Address Line 2
City	State
Post Code	Country

	Not True	Somewhat True	Always True
Considerate of other people's feelings
Restless, overactive, cannot stay still for long
Often complains of headaches, stomach-aches or sickness
Shares readily with other youth, for example books, games, food
Often loses temper
Would rather be alone than with other youth
Generally well behaved, usually does what adults request
Often seems worried
Helpful if someone is hurt, upset, or feeling ill
Constantly fidgeting or squirming
Has at least one good friend
Often fights with other youth or bullies them
Often unhappy, depressed or tearful
Generally liked by other young people
Easily distracted, concentration wanders
Nervous in new situations, easily loses confidence
Kind to younger children
Often lies or cheats
Picked on or bullied by other young people
Often volunteers to help others (parents, teachers, children)
Thinks things out before acting
Steals from home, school, or elsewhere
Gets along better with adults than with other young people
Many fears, easily scared
Good attention span, sees tasks through to the end

YMCA Summer Holiday Camp January 2020

Participant (Camper) Details

Emergency Contact Details

Medical and Health Details

On Camp

Permission & Important Information