Register
 

Young Person Name *
Young Person Name
This information helps us suggest pick up and drop off locations
Medicare Information is required in the event that medical attention is needed.
Name - Phone Number - Relationship to young person
Name - Phone Number - Relationship to young person
Name - Contact Number
Name - Phone Number - Relationship to young person
Does the young person have a diagnosis or disability?
Does the young person have any allergies?
Does the young person take any medication?
Does the young person have any behavioural concerns?
Does this child require any assistance with personal care?
Does the young person have any dietary requirements?
Are there any activities that the young person is restricted from participating in?
Medical Treatment Authorisation *
Being the parent or legal guardian I understand that I will be notified in the case of medical emergency. However in the event that I cannot be reached, I authorise the calling of a doctor and the providing of necessary medical services in the event that my young person is injured or becomes ill. I understand that Camp Kiah will not be responsible for medical expenses incurred on the basis of this authorisation. I also understand that the trainer(s) from Camp Kiah reserve the right to restrict this young person from any activity that they do not feel is within the physical capabilities of the young person. I have been made aware of the risks inherent in this activity and understand that this consent form covers the camp on the above date.
Consent for Camp *
Being the parent or legal guardian of the young person named above, I do hereby consent to the participation of this young person in the camp activities conducted by Camp Kiah. I certify that this young person is physically fit and adequately prepared to participate in this activity.