Student name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth *

MM

DD

YYYY

Sex *

Male

Female

Prefer not to say

Name of parents / guardians *

If only one parent or guardian, please leave the second box blank.

First Name

Last Name

Parent / guardian address (during camp) *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Has the student had any recent injuries or illness? *

Yes

No

Does the student have any condition that may prevent them from participating? *

Yes

No

Do you object to the use of digital photography / videography during camp and the public display of this? *

Yes

No

Does the student suffer from asthma? *

Yes

No

Suffer from hay fever? *

Yes

No

Suffer from travel sickness? *

Yes

No

Have any medical or behavioural diagnosis? *

Yes

No

Take any form of medication? *

Yes

No

Have any allergies? *

Yes

No

Have up to date vaccinations for measles & tetanus? *

Yes

No

Have any dietary requirements? *

Yes

No

Do you object to the administration of blood or blood products including transfusion if required by a practitioner? *

Yes

No

Is there anything else we should know about your students health and ability to partake in the activities offered? *

If yes, please detail below.

Yes

No

*

I declare that the information given above is correct. I understand that the discovery of false or incomplete information may jeopardize my child’s right to a place at the camp. I have read and understood the Terms & Conditions and (including the cancellation policy) as set out on the website and I agree to the terms therein. In the event of accident or emergency, I authorise the Directors to take such action as may seem necessary at the time in question. I agree to collect my child in the event of misconduct, without hesitation or question and will be contactable throughout the time of the camp.