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CONNECT Youth Camp 2021 Registration
When: September 10th-12th 2021
Times: 7pm Friday - 2pm Sunday
Location: Willow Creek Campsite (2581 Range Road, Willow Creek)
Cost: $95 per person
Contact Riley for more details: m: 0430072147, e:
riley_vhbc@internode.on.net
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Full Name of Camper
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Date of Birth
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Your answer
Gender
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Female
Male
Camper mobile no. (if applicable)
Your answer
Camper email (if applicable)
Your answer
Name of Parent / Care Giver
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Your answer
Contact Number
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Email Address
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Your answer
Camper Year Level
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7
8
9
10
11
12
Leader
Address
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Suburb
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Postcode
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Medical Needs
*
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Dietary Requirements
*
Your answer
Allergies
*
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Emergency Contact Person
*
Your answer
Relationship to Camper
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Your answer
Emergency Contact Number
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Medicare Number
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Your answer
Private Health Insurance
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Yes
No
Private Health Insurance Provider
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Private Health Insurance Policy Number
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Ambulance Cover
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Yes
No
I give permission for an ambulance to be called for my young person in the case of an emergency
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Payment of $95 for camp (If finances are a problem, please speak to Riley. We don't want anyone missing out because of money)
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Bank Transfer. Acc Name: Victor Harbor Baptist Church. BSB: 704 922. Acc No: 100011935 (please label transaction with "name camp" - ie. "Riley camp"
Cash (please give to Riley at Friday night youth or bring to camp)
I would like to talk with Riley about other options for finance
Transport: Drop off & pick up will be at the campsite.
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That works for us.
I need help getting my young person to/from camp
I have spare seats in my car to help with transport if others need it
I give permission for my young person to attend Connect Youth Camp 2021
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Yes
No
I understand that I'll receive an email closer to camp with all the details of what to bring, along with an attached consent form that MUST be signed and brought to camp for my young person to attend.
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Yes
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