E3 Big Camp • St Mark's Anglican Church Berowra

1st Camper 0

Parent/Caregiver Details

While registering for this camp, have you filled in the Parent/Caregiver Details section already? *

Parent First Name *

Parent Last Name *

Parent/Guardian's Mobile Number *

Email for updates about camp *

Home Address *

Home Address Line 2

Home City *

Home State *

Alternative Emergency Contact Name (First and Last)

Alternative Emergency Contact Number

Are you fully Licenced and willing to help us drive youth to or from the campsite in a vehicle you own?

Camper Details

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

Mobile Number

Medicare Number

Medicare Reference Number

Has your child recently experienced any of the following? *

Please provide any extra relevant information from your answer above *

Will your child require medication while on camp? (please share details)

Does your child require a special diet or have any allergies? (please share details) *

Is this the last youth you are registering for camp? *

Permission

I give permission for the children named above to attend:
St Marks Youth Mini Camp 2024
the dates of: 22/1/2025 - 26/1/2025

I authorize the leader in charge of the above mentioned group where it is impracticable to communicate with me,
to arrange for my child/children to receive such medical treatment as the leader may deem necessary while in the care of the leader.
I further authorise the use of an ambulance if in the leader’s judgment it is necessary.
I accept responsibility for payment of all expenses associated with such treatment.

I appreciate that every care will be taken by the leaders of the above mentioned group.

I understand that photos/video will/may be taken during the course of youth activities
and I am willing for my child to be filmed/photographed in appropriate settings.
I am also willing for these photos/footage to be used in the context of promoting the ministry
(eg on a brochure for the group) without identifying their name or details.
My child is also willing for this to take place.

I give permission for my child to be transported in a private vehicle during the event
under appropriate supervision as arranged by the leaders of the afore mentioned group.

Today's Date *

Please sign (type) your name *

Please click next to complete registration and proceed to payment

2nd Camper 0

Parent/Caregiver Details

While registering for this camp, have you filled in the Parent/Caregiver Details section already? *

Parent First Name *

Parent Last Name *

Parent/Guardian's Mobile Number *

Email for updates about camp *

Home Address *

Home Address Line 2

Home City *

Home State *

Alternative Emergency Contact Name (First and Last)

Alternative Emergency Contact Number

Are you fully Licenced and willing to help us drive youth to or from the campsite in a vehicle you own?

Camper Details

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

Mobile Number

Medicare Number

Medicare Reference Number

Has your child recently experienced any of the following? *

Please provide any extra relevant information from your answer above *

Will your child require medication while on camp? (please share details)

Does your child require a special diet or have any allergies? (please share details) *

Is this the last youth you are registering for camp? *

Permission

I give permission for the children named above to attend:
St Marks Youth Mini Camp 2024
the dates of: 22/1/2025 - 26/1/2025

I authorize the leader in charge of the above mentioned group where it is impracticable to communicate with me,
to arrange for my child/children to receive such medical treatment as the leader may deem necessary while in the care of the leader.
I further authorise the use of an ambulance if in the leader’s judgment it is necessary.
I accept responsibility for payment of all expenses associated with such treatment.

I appreciate that every care will be taken by the leaders of the above mentioned group.

I understand that photos/video will/may be taken during the course of youth activities
and I am willing for my child to be filmed/photographed in appropriate settings.
I am also willing for these photos/footage to be used in the context of promoting the ministry
(eg on a brochure for the group) without identifying their name or details.
My child is also willing for this to take place.

I give permission for my child to be transported in a private vehicle during the event
under appropriate supervision as arranged by the leaders of the afore mentioned group.

Today's Date *

Please sign (type) your name *

Please click next to complete registration and proceed to payment

3rd Camper 0

Parent/Caregiver Details

While registering for this camp, have you filled in the Parent/Caregiver Details section already? *

Parent First Name *

Parent Last Name *

Parent/Guardian's Mobile Number *

Email for updates about camp *

Home Address *

Home Address Line 2

Home City *

Home State *

Alternative Emergency Contact Name (First and Last)

Alternative Emergency Contact Number

Are you fully Licenced and willing to help us drive youth to or from the campsite in a vehicle you own?

Camper Details

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

Mobile Number

Medicare Number

Medicare Reference Number

Has your child recently experienced any of the following? *

Please provide any extra relevant information from your answer above *

Will your child require medication while on camp? (please share details)

Does your child require a special diet or have any allergies? (please share details) *

Is this the last youth you are registering for camp? *

Permission

I give permission for the children named above to attend:
St Marks Youth Mini Camp 2024
the dates of: 22/1/2025 - 26/1/2025

I authorize the leader in charge of the above mentioned group where it is impracticable to communicate with me,
to arrange for my child/children to receive such medical treatment as the leader may deem necessary while in the care of the leader.
I further authorise the use of an ambulance if in the leader’s judgment it is necessary.
I accept responsibility for payment of all expenses associated with such treatment.

I appreciate that every care will be taken by the leaders of the above mentioned group.

I understand that photos/video will/may be taken during the course of youth activities
and I am willing for my child to be filmed/photographed in appropriate settings.
I am also willing for these photos/footage to be used in the context of promoting the ministry
(eg on a brochure for the group) without identifying their name or details.
My child is also willing for this to take place.

I give permission for my child to be transported in a private vehicle during the event
under appropriate supervision as arranged by the leaders of the afore mentioned group.

Today's Date *

Please sign (type) your name *

Please click next to complete registration and proceed to payment

4th Camper 0

Parent/Caregiver Details

While registering for this camp, have you filled in the Parent/Caregiver Details section already? *

Parent First Name *

Parent Last Name *

Parent/Guardian's Mobile Number *

Email for updates about camp *

Home Address *

Home Address Line 2

Home City *

Home State *

Alternative Emergency Contact Name (First and Last)

Alternative Emergency Contact Number

Are you fully Licenced and willing to help us drive youth to or from the campsite in a vehicle you own?

Camper Details

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

Mobile Number

Medicare Number

Medicare Reference Number

Has your child recently experienced any of the following? *

Please provide any extra relevant information from your answer above *

Will your child require medication while on camp? (please share details)

Does your child require a special diet or have any allergies? (please share details) *

Is this the last youth you are registering for camp? *

Permission

I give permission for the children named above to attend:
St Marks Youth Mini Camp 2024
the dates of: 22/1/2025 - 26/1/2025

I authorize the leader in charge of the above mentioned group where it is impracticable to communicate with me,
to arrange for my child/children to receive such medical treatment as the leader may deem necessary while in the care of the leader.
I further authorise the use of an ambulance if in the leader’s judgment it is necessary.
I accept responsibility for payment of all expenses associated with such treatment.

I appreciate that every care will be taken by the leaders of the above mentioned group.

I understand that photos/video will/may be taken during the course of youth activities
and I am willing for my child to be filmed/photographed in appropriate settings.
I am also willing for these photos/footage to be used in the context of promoting the ministry
(eg on a brochure for the group) without identifying their name or details.
My child is also willing for this to take place.

I give permission for my child to be transported in a private vehicle during the event
under appropriate supervision as arranged by the leaders of the afore mentioned group.

Today's Date *

Please sign (type) your name *

Please click next to complete registration and proceed to payment