Day Camp 2010

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THE REGISTRATION FORM.

Ensure that you fill out all fields in order to complete registration properly.

If you are registering more than one child in a family then you will need to complete the details for each child separately. Please select the fee appropriate to the number of children that you are registering. (ie - if you are registering 3 children then select the fee for 3 children for each child that you enter. This will create a total fee of $120 for the 3 children.)

There will be an antispam protection box at the bottom of the first page in red. You must follow the instructions in this box and enter the letters that you see in order to proceed.

If you encounter any problems with the registration process then please call David on 0414545855.

How many people are you registering?

(including yourself)
Fill in your registration information on this page. If you are registering additional people, you will be able to enter their registration information after you complete this page and click "Continue".

Day Camp Fee(s) *

$ 70.00 One child
$ 50.00 Two children (each child)
$ 40.00 Three Children (each child)
$ 30.00 Four Children (each child)

[x] Payment must be sent by cheque, money order or direct deposit within 7 days

Email Address *

Day Camp Registration

Day Camp Registration Details

Child's First Name *

Child's Last Name *

Birth Date *

(clear)

Gender *

Female Male ( unselect )

What school does this child attend? *

Current School year *

Special Dietary Needs

Please provide basic details re any special dietary requirements for this child. You will be contacted if necessary for further details or you may contact one of the camp directors once you have completed registration.

Critical Health Information

Please provide brief details regarding any critical health information for this child such as allergies or medication requirements. You may also include any special behavioural advice for your child that will help your child's leader to help them to have the best experience of Day Camp. You will be contacted for further information about these details once you have completed registration.

Parent's First Name *

Please enter your first name

Parent's Last Name *

Please fill in your last name

Home Phone *

Mobile *

Work phone

Street Address *

Suburb *

Postal Code *

Name of Emergency Contact *

Please enter the name of another person who the Day Camp Director can contact in the case of an emergency during Day Camp 09.

Relationship *

Please identify the relationship of the emergency contact to this child

Emergency Contact Number *

Please enter a contact number for this emergency contact that can be used during the Day Camp 09 week in the case of an emergency. Emergency contacts will only be used where the parent is unavailable in an emergency. You may enter multiple numbers by separating them with a '/'

Acknowledgement of risks *

Yes No
please select 'yes' to give your consent for this child to take part the programmed activities of Pitt Town Day Camp. In selecting 'yes' you will also agree to indemnify Pitt Town Anglican Community Church, its employees and volunteer workers against any claim arising from any accident involving this child, or any occurrence at the chosen camp site which, but for this indemnity, may give rise to a claim for damages. This does not include an indemnity from actions that are negligent. The leaders and helpers for Day Camp will ensure that risks are appropriately identified and responded to throughout the camp. You may discuss this further with one of the Day Camp directors.

Consent for use of images of this child *

Yes No
Please select 'yes' if you give permission to Pitt Town Anglican Community Church to use appropriate photographs or videos taken of or including this child during the Day Camp program for promotion or publicity of Day Camp only. This will include allowing us to include your child in the Day Camp video that will be provided to campers at the end of Day Camp. It may also include publication of images from Day Camp in the form of photographs and/or videos on the web and will remain subject to the exclusive control of Pitt Town Anglican Community Church. You may contact one of the Day Camp Directors if you wish to discuss this further and we are happy to accommodate special requests where there are legal or ethical issues. Please contact us at daycamp@pitttown.anglican.asn.au to speak about this further.

Permission to seek medical attention *

Yes No
Please select 'yes' if you give permission for the Day Camp Director to seek medical attention for your child in the case of an emergency or at the advice of the accredited First Aid Officer. We will always attempt to contact you prior to taking any action. You may discuss this further with one of the Day Camp Directors.

Other relevant information

Please include any other relevant information that the Day Camp leaders should be aware of to ensure the best experience for your child.

Day Camp 2010

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