2027 Junior Summer Camp – WA Simple Events

Attendee Details

First Name

Last Name

Attendee Email

Date of Birth

Age at Event Date

Gender

I give permission for images and videos of the attendee to be taken and used by the Seventh-day Adventist Church – Western Australia and their representatives. These images and videos will be used appropriately in the form of further advertising, Connect magazine articles, social media posts and on our web page. Please contact chloewatson@adventist.org.au if you have any concerns or wish to discuss further.

Yes

No

Accommodation Buddy Preferences

List 3 friends who you would like to room with. Please note that these groupings are preferences and are not guranteed.

Accommodation Buddy Preference 1

Accommodation Buddy Preference 2

Accommodation Buddy Preference 3

Activity Selection

We ask that you please rank the activities from 1 to 5 (1 being the activity you would like to do most)

First Preference

Second Preference

Third Preference

Fourth Preference

Fifth Preference

All afternoon activities will take place at the water front and the activity options will be selected by the participants while at Summer Camp.

Attendee Swimming Ability

Parent/Guardian Details

Parent/Guardian #1

First Name

Last Name

Email

Phone

Relationship to Attendee

Add another parent/guardian

Yes

No

Parent/Guardian #2

First Name

Last Name

Email

Phone

Relationship to Attendee

Secondary Emergency Contact

This person will be contacted in case of emergency if the attendees parent/s or guardian/s cannot be reached.

First Name

Last Name

Phone

Relationship to Attendee

Medical Details

Please complete your medical and emergency details below.

All information is stored securely and accessed only by authorised personnel (i.e. event leaders, first aiders).

For event safety, it is vital that the information is up to date when the event begins. If you have any questions or would like to update the medical information you provide, please do not hesitate to contact us at chloewatson@adventist.org.au

General

Medicare Number

Position on Medicare Card

Do you have ambulance cover?

Ambulance Cover Provider

Do you have private health insurance?

Private Health Insurance Provider

Private Health Insurance Member Number

Do you object to transfusions?

Date of last tetanus vaccination

Any non-medical dietary requirements?

Please advise any other non-medical dietary requirements

Medical Conditions

Please list below any known medical conditions or care notes, including:
allergies (anaphylactic), allergies (non-anaphylactic), anorexia/ eating disorders, asthma, autism, bed-wetting, blackouts/ dizziness/ fainting, bleeding disorder, diabetes, disability, eczema/ skin condition, epilepsy/ seizures, hearing impairment, heart condition, joint/ muscle/ bone problems, migraines, operations, phobia, recent illness, sleep walking, sight impairment, travel sickness, mental health issue. heart problems, respiratory problems, travel sickness, any other medical issue or care note.
Please email all action plans (i.e. anaphylaxis, asthma, diabetes) to wayouth@adventist.org.au

Add medical condition/care note

Medical Condition/Care Note 1

Symptoms

Triggers

Medication

Care Instructions

Add another medical condition/care note

Medical Condition/Care Note 2

Symptoms

Triggers

Medication

Care Instructions

Add another medical condition/care note

Medical Condition/Care Note 3

Symptoms

Triggers

Medication

Care Instructions

Add another medical condition/care note

Medical Condition/Care Note 4

Symptoms

Triggers

Medication

Care Instructions

Medical Contact (Optional)

Add doctor’s details

Doctor’s Name

Practice Name

Phone Number

Non-Prescription Medication

Should my child feel unwell, I give permission for the Summer Camp staff to provide:

Paracetamol

Yes

No

Ibuprofen

Yes

No

Anti-Histamine

Yes

No

Ticket Selection & Payment

Do you require a payment plan?

Yes

No

Attendee Fee

Junior Summer Camp Fee – $415

Junior Summer Camp Attendee Fee – Payment Plan

$103.75 for each week, for 4 installments

I understand that a $103.75 charge will be automatically charged weekly for the next 3 weeks from the payment method (card) I provide on this form.

Yes

No

Do you require bus transport to &/or from Mornington Adventure Camp?

Yes

No

Transport Fee

Bus To Mornington Adventure Camp (Tuesday, 19 January) – $20

Bus From Mornington Adventure Camp (Sunday, 24 January) – $20

No payment items has been selected yet

Pay with Card (Stripe)

Booking Submission

The information supplied in this registration form is true and correct.

I have read and agree to the Terms and Conditions and Privacy Policy