Kids Camp Registration

Kids Camp Registration
Are you coming as a....*
Please select from drop down list
Which camp would you like to register for?*
Please select from drop down list
Returning or New?
Personal Details
Name*
First and last name
Date of Birth*

DayMonthYear
Gender*
Please select from drop down list
Street Number*
Street Name*
Suburb
Town*
Postcode*
Email Address*
This needs to be the parent or caregiver and will be used for all correspondence
School attending*
School year*
Caregivers Details
Name of first contact person*
Relationship*
Mother, father, grandparents, friend etc
Phone 1*
Phone 2
Name of second contact person*
Relationship*
Mother, father, grandparents, friend etc
Phone 1*
Phone 2
Camp Information
Days coming (Senior)

Monday 30th JuneTuesday 1st JulyWednesday 2nd JulyThursday 3rd JulyFriday 4th July
Days coming (Junior)

Monday 30th JuneTuesday 1st JulyWednesday 2nd JulyThursday 3rd JulyFriday 4th July
Bus Pick up/drop off (Senior/ Junior)

Richmond (Outside Richmond School)Brightwater (Outside Brightwater School)MondayTuesdayWednesdayThursdayFriday
Bunk selection*

TopBottomEither
Does your child receive additional support at school? eg Teacher Aid*

YesNo
Are you eligable for funding support?

NoYes - OSCAR subsidyYes - other funderOther
Any information that we need to know to better care for your child
Cultural needs, Fears, bed wetting, ADD, behavior, sleep walking, anxieties etc
Medication that will be required while your child is at camp
Include any medical conditions (allergies, asthma, heart, blood etc)
Dietary requirements.
Vegetarian, gluten free, dairy free, vegan etc
Friend Requests
Friend 1
Gender and age appropriate
Friend 2
Gender and age appropriate
Referee Details
Referee's name*
Please ask them first
Their phone number*
Their email address*
Relationship to you*
Employer, church pastor, teacher, coach etc
Submit
Person filling in this form*
Relationship to camper*
Please select from drop down list
I give consent for any photos and videos taken during camp to be shared on Teapot Valley's YouTube channel and I am happy for the video link to be sent to other families that also have children on the same camp. Photos and videos may also be posted on the Teapot Valley website.*

YesNo
Should be Empty:

Kids Camp Registration

Personal Details

Caregivers Details

Camp Information

Friend Requests

Referee Details

Submit