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Rising Women: Mother Daughter Camp Registration Form - May 19th - 21st 2023
Register for our May 19-21 Camp at Sacred Hearth Sanctuary in the Byron Hinterland (near Yarrakorra)
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Email
*
Your email
Full Name*
Enter the name of the adult attending camp
*
Your answer
Your Mobile Number
*
Your answer
Your Email Address
*
Your answer
Child's Full Name
Enter the full name of the child attending this camp.
*
Your answer
Child's Date of Birth
Enter the attending child's date of birth.
*
MM
/
DD
/
YYYY
Child's Gender
*
Female
Non-binary
Please let us know your child's pronoun preferences
she/her
they/them
Clear selection
Child's Diet
Please provide details of dietary requirements and food allergies.
*
Your answer
Child's Medical Status
Please provide details of all Medical Conditions, including medication, dosages, and triggers we need to be aware of.
*
Your answer
Child lives with
Please select who the child is living with.
*
Both Parents
Shared between parents
Mother only
Father only
Other:
Additional information about the Child
Is there anything else that we may need to know about your child in regards to current challenges or needs?
Your answer
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