EmailMe Form - Pre-Holiday Camp Registration Form

Leader's Name: *

First Last

Please list the CAMP/S attending:
(If more than one camp during the same holiday period, list all camps) *

Email address: *

Name of an Emergency Contact: *

First Last

Relationship to you *

Their primary contact number *

Their secondary contact number

Medical information *

List any dietary requirements (eg Gluten Free, Vegetarian, ANAPHYLACTIC and the severity (mild, serious, potentially fatal) *

Please list any times you are aware of, that you will need to sign out, during the week. Eg (Work)

Under 18's Please ensure that you get your parent/guardian to sign this form BEFORE you come to camp

It is Camp Clayton's policy that no medications are administered by Camp staff or leaders without prior arrangement with parents at registration (ie medications provided by parents as necessary for current conditions) or as advised by medical staff on consultation. The only exception to this is paracetamol which may only be administered with the following signature from a legal parent or guardian (for those under 18 years)

Please tick to give permission for paracetamol to be administered to your child in the case of mild pain? (This authorisation applicable to this camp only) *

Yes

No

I'm over 18

Please tick to give permission for your son/daughter to volunteer at Camp Clayton and hereby give permission for Camp Staff acting on behalf of Christian Youth Centre Inc (Camp Clayton) to arrange for any necessary medical attention required and charge the same to me. *

Yes

No

I'm over 18

Please tick if you give permission for Camp Clayton to use your child's photo in advertisements

Yes

No

Please call to ask me

Please sign to confirm that the information you have provided is true and accurate *

Clear

Please ask you legal guardian or parent to use the mouse or finger if using a touchscreen to sign

Name of person signing *

First Last

Any other comments