Disclaimer - All information provided in this form is private and confidential, and will only be shared with your key youth group leader for camp purposes.

Personal Information
Name *
Name
Gender *
Date of Birth *
Date of Birth
I am a... *
What youth group are you coming to camp with?
Dietary Requirements *
Please select as many that apply to you. If none, check "N/A".
Medical Information
Make sure your key youth leader is aware of any medical needs for camp, as they are responsible for you during camp.
Do you have any pre-existing medical conditions/disabilities? *
Do you take any medication regularly? *
Emergency Contact
Contact Information for a parent/guardian in case of an emergency
Name *
Name
Mother, Father, Grandad, Aunty etc
Promotional Disclaimer
I give permission for any photo and/or video material taken of me at camp to be used in future promotional material. *