2025 Junior Summer Camp – wa.bluevineyardevents.com

Applicant Details

First Name

Last Name

Email

Phone

Date of Birth

Age at Event Date

Gender

T-Shirt Size

Campers will be provided with a T-Shirt to be used during our Colour Run activity.

Size Guide:

XS – 89cm Chest

S – 94cm Chest

M – 99cm Chest

L – 105cm Chest

XL – 111cm Chest

2XL – 117cm Chest

3XL – 123cm Chest

4XL – 129cm Chest

https://www.kmart.com.au/product/plain-crew-neck-t-shirt-s140827/?selectedSwatch=White

T-Shirt Size

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

Activities at Summer Camp this year will be divided into 3 sessions:

Morning Session #1

Morning Session #2

Afternoon Session

We ask that you please rank the activities for both morning session #1 & #2 from 1 to 5 (1 being the activity you would like to do most)

Morning Activity Session One

Morning Activity Session Two

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

Emergency Contact

First Name

Last Name

Phone

Relationship to Attendee

Secondary Emergency Contact

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 wayouth@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

Do you require a payment plan?

Yes

No

Attendee Fee

2025 Junior Summer Camp Fee – $400

Junior Summer Camp Attendee Fee – Payment Plan

$33.34 for each week, for 12 installments

I understand that a $33.34 charge will be automatically charged weekly for the next 11 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, 14 January) – $20

Bus From Mornington Adventure Camp (Sunday, 19 January) – $20

No payment items has been selected yet

Pay with Card (Stripe)

Application 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

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Water Skiing
Abseiling
Climbing Wall/Flying Fox
Mountain Biking
Stand-Up Paddleboarding/Kayaking
Cooking (Bread & Smoothie Making)
Wheels (Billy Carts & BMX)
Targets (Archery & Other Targets)

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Water Skiing
Abseiling
Climbing Wall/Flying Fox
Mountain Biking
Stand-Up Paddleboarding/Kayaking
Cooking (Bread & Smoothie Making)
Wheels (Billy Carts & BMX)
Targets (Archery & Other Targets)