Summer Camp Booking Form

Children's Summer Camp 2022

Camp Application Form, Parental Permission and Medical Information
FORM 1 - Camp Application Form 2022

Saturday 10th December to Sunday 18th December 2022 at Goodland Estate, Seringveld Conservancy. (Please submit one form per child). Cost: 1st child - R3 000.00, Siblings - R2 750.00)
Child's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Age of child in December 2022 (eg. 9)*
School Name: *
Class / Grade*
Class Teacher*
BoyGirl
YesNo
YesNo
Any important information we should know (eg: special diet, social problems, medicine,etc.): *

Parent / Legal Guardian Information
Parent 1 (Primary contact person for emails and updates):

First NameLast Name
Email
example@example.com
Cell Number:
Parent 2:

First NameLast Name
Email
example@example.com
Cell Number:
Legal Guardian: (if not a parent)

First NameLast Name
Email
example@example.com
Cell Number:
Relationship to child:
Parent / Guardian Electronic Signature*

Costs

First child: R3 000.00. Siblings: R2 750.00.
Payment:

Please make EFT payments to The Christian Community savings account at ABSA Randburg, Branch Code 632005, Account Number 9 093 788 359.

Please put child's surname as reference. Kindly send Proof of Payment to Sarah at ssleeman@michaelmount.co.za. Deadline for applications and payment is 25 November 2022.

Please Note:

Although we have tried to keep the cost down to a minimum, we will consider a fee reduction where needed and possible. Please contact Rev. Knausenberger/William Bester should this be a concern for you.

Transport arrangements are not included. Please make your own arrangements for getting your child to and from Goodland Estate. The children are accepted to the camp on a first-come-first-serve basis. To ease our planning please ensure that your application with payment is handed in as soon as possible.

Upon confirmation of the application a map with directions to Goodland will be emailed to you, as well as a ‘to bring’ list for more detailed information regarding what to pack.
I am able to contribute a donation to assist those children for whom the fee is unaffordable of:
Please contact ssleeman@michaelmount.co.za if you would like to do so.

FORM 2 - Medical Information and Indemnity
Emergency Contact Person (contactable during the camp): *

First NameLast Name
Identity Number:*
Relationship to child:*
Email
example@example.com
Cellphone Number:*

Area CodePhone Number
YesNoOther
I hereby advise that The Christian Community's duly authorised representatives at the Summer Camp 2022 should note the following (please state aspects that such duly authorised representative should be aware of such as allergies and / or other medical conditions):
YesNo
If you answered yes above, please list the medication/s and how often they should be taken:
I further advise of the following medical aid information in case of medical treatment and or hospitalisation being required:
Name of Medical Aid Fund: *
Membership Number: *
Residential Address of Parent / Guardian:*
Postal Address of Parent / Guardian: *
Name and address of employer:
Permission
1. I hereby give permission for child (named above) to go on the Christian Community Summer Camp at Goodland Estate from 10 to 18 December 2022.

2. I accept that all reasonable precautions will be taken to ensure the safety and welfare of my aforesaid child; however, I understand that participation therein is at the sole risk of the participant and / or his / her legal guardian. Accordingly, I confirm and agree that The Christian Community shall not be liable for any loss, mishap, injury or damage of whatever nature which may be suffered by my said child during the Summer Camp 2022, whether or not same is suffered in or near the facility of any employee of The Christian Community and / or under such employee's supervision and irrespective of whether such loss, mishap, injury or damage is caused by fire, storm, flood, riot, civil commotion, theft, robbery, accident or any other cause whatsoever, and further irrespective of whether such loss, mishap, injury, or damage is caused by any act, omission or default on the part of The Christian Community, its employees and / or its agents and / or its children. In furtherance of this, I indemnify and hold The Christian Community harmless against and such loss, mishap, injury or damage.

3. I further agree that I shall be responsible for the payment of any medical and / or hospital accounts, where applicable, should an injury be sustained by my said child and, in this regard, I cede my powers as parent / guardian to an authorised representative of The Christian Community should medical treatment of any nature whatsoever be deemed necessary for my child by such duly authorised representative.
Parent / Guardian Electronic Signature:*
Date*

DayMonthYear
Should be Empty:

Children's Summer Camp 2022

FORM 1 - Camp Application Form 2022

Parent / Legal Guardian Information

Costs

FORM 2 - Medical Information and Indemnity

Permission