PWSA VIC 2023 Time Out Camp registration

2024 TIME OUT CAMP

Registration Form
We are very excited to be able to bring our community together in this unique supportive and fun environment.

The Time Out Camp is designed to encourage those living with Prader-Willi Syndrome and their families to develop life-long friendships, build resilience and self-confidence, and have fun in a supportive and PWS-friendly environment.

Our main focus is to encourage inclusion for all, by providing a range of fun outdoor activities suited to all abilities and ages. So, no matter how young or old you are, there is something to be gained by all who attend the Time Out Camp.

CALCULATING THE FEES

The fee for each person attending is $150, an average price rather than aged based. (Children 2 and Under are free). The cost of registration is still heavily subsidised by PWSA Vic. Price per family will be capped at $600.
Is the individual with PWS on this registration form over 18?*

YesNo
Number of individuals with PWS attending
Name*

First NameLast Name
Fee
Parent/Carer attendance

If under 18 a parent or Carer (family member or friend) must attend even if supported by a employed Support Worker. Individuals over 18 may attend without a parent/Carer, but support of an employed Support Worker is generally required. Please Note: if attending with a Support worker select 0 for number of Parent/Carers attending. Support Workers should complete their own registration using the Carer registration form. Support Workers engaged through a participants NDIS funding are not required to pay a registration fee.
Number of Parent/Carer (not paid Support workers) attending:*
Parent/Carer 1 Name

First NameLast Name
Parent/Carer 2 Name

First NameLast Name
Fee:
How many of your group attending are siblings of the individual with PWS?
Number of others attending 12yo and over:*
Fee:
Number of other Children attending between 3yo and 11yo:*
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Fee:
Number of other Children attending 2yo and under:*
(FREE)
Name

First NameLast Name
Name

First NameLast Name
TOTAL number of people attending:
TOTAL Fees:
Payment of the above agreed amount. Option to pay online at completion of this registration is available.

Yes, I will make full payment online today during the completion of this registration. I will indicate later if I require a receipt for NDIS purposes.I will not be making a payment today but I will make a payment to PWSA Vic upon receipt of payment invoice issued on completion of this online registration. Enter $0 in agreed payment field below NB: Payment is due within 7 days of online registration. Non-payment may result in your application being cancelled.I have discussed my payment with PWSA Vic . Enter the agreed amount below if making any payment at this time or enter $0
The Amount I have agreed to pay is:
Please enter amount here

DETAILS OF THE PERSON LIVING WITH PWS ATTENDING:
Full Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

SuburbState

Post Code
Date of Birth*

DayMonthYear
Phone Number: (if applicable)
T-Shirt Size:*
Child and Adult sizes available
Meal Size: These meals are nutrient dense, and therefore large with reduced Calories*

Small (approx. 700 Calories)Medium (approx. 1200 Calories) Average adult serveLarge (approx. 1800 Calories) 1.5 x Average adult serveNone - I will byo baby food (option for 2yo and under)

DETAILS OF OTHER ATTENDEES:

Parents/Carers
Name of Parent/Carer 1:*

First NameLast Name
Parent/Carer 1. Phone Number:*
Parent/Carer 1. T-Shirt Size:*
Parent/Carer 1 - Meal Size: These meals are nutrient dense, and therefore large with reduced Calories*

Small (approx. 700 Calories)Medium (approx. 1200 Calories) Average adult serveLarge (approx. 1800 Calories) 1.5 x Average adult serve
Name of Parent/Carer 2:*

First NameLast Name
Parent/Carer 2 Phone Number:
Parent/Carer 2. T-Shirt Size:*
Parent/Carer 2 - Meal Size: These meals are nutrient dense, and therefore large with reduced Calories*

Small (approx. 700 Calories)Medium (approx. 1200 Calories) Average adult serveLarge (approx. 1800 Calories) 1.5 x Average adult serve

DETAILS OF OTHER ATTENDEES:

CHILD(REN) AGED 2YO AND UNDER
Name of other Child (2yo and under) 1:*

First NameLast Name
How old is this child?*
T-Shirt Size:*
Meal Size:*

Small (approx. 700 Calories)None - I will byo baby food
Name of other Child (2yo and under) 2:*

First NameLast Name
How old is this child?*
T-Shirt Size:*
Meal Size:*

Small (approx. 700 Calories)None - I will byo baby food

DIETARY INFORMATION:
Does anyone listed on this form have any FOOD ALLERGIES? (Enter food intolerences/allergies in Dietary requirements)
Note: If more than one person on registration please list name of person/s with these requirements.
If an allergic reaction is triggered would this require emergency medical intervention or use of an EpiPen? Are you or an attending family member able to administer the EpiPen?
Does anyone listed on this form have any special dietary requirements? Intolerence, cultural or lifestyle.
Note: If more than one person on registration please list name of person/s with these requirements.
MEDICAL INFORMATION:
Does anyone listed on this form have any medical conditions that the accompanying carer should be aware of? Answer only yes or no below.
Please Note: PWSA Vic is unable to retain medical records.; If for any reason the primary carer of the individual who may require treatment leaves the camp grounds they must inform the camp organisers of any possible requirements..

DETAILS OF EMERGENCY CONTACT/S:

(NOT ATTENDING THIS CAMP)
Name of Emergency Contact 1:*

First NameLast Name
Phone Number:*
Relationship to the person with PWS:*
Name of Emergency Contact 2: if available

First NameLast Name
Phone Number:
Relationship to the person with PWS:

PRIVACY STATEMENT:

To be agreed to by the person responsible for all those listed on this form
Please tick*

I have read and understood the above statement and agree to the terms as outlined

TERMS AND CONDITIONS:

To be agreed to by the person responsible for all those listed on this form
- I give my consent for all those listed on this form to participate in the PWS Time Out Camp and all activities organised by PWSA Victoria during the Time out camp at Camp.
- I know that if any participant is unwell or suffers any injury, I must report it to the carer and/or camp organisers. The provision of First Aid will be available at the camp and administered by suitably qualified staff.
- In the event of a medical emergency, all efforts will be made to contact the parent or carer listed, emergency contacts on this form in the first instance. If contact cannot be made, I authorise medical attention to be sought immediately and administered if required. Also, I consent to the individual being transported in a privately owned vehicle driven by camp organisers (or their representative) or by ambulance to the closest appropriate medical facility if required. Ambulance and any other medical expenses are the responsibility of the individual, family member or representative completing this registration.
- I agree that any medical information contained in this registration form or given to camp or PWSA Vic representatives may be made available to appropriate people rendering assistance or from whom advice may be appropriate.
- I understand that in the event of inappropriate behaviour or behaviour that poses a danger to others during the camp, the participant/s will be asked to leave. I further understand that in such circumstances, any costs associated with his/her/their return will be the responsibility of the person attending or their family.
- I understand that personal property such as mobile phones, iPads, etc. are permitted for limited use at the camp, but I take sole responsibility for that property. Camp organisers will not be responsible for locating lost property or providing reimbursement.
- I acknowledge and consent to the risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless PWSA Victoria and all its respective officers, agents, and representatives from any and all liability for injuries to the participant/s arising out of travelling to, participating in, or returning from the Time Out camp.
Please tick*

I have read and understood the above statement and agree to the terms as outlined

CONSENT TO PHOTOGRAPHY/VIDEOGRAPHY:

To be agreed to by the person responsible for all those listed on this form
The Prader-Willi Syndrome Association of Victoria (PWSA Vic) reserves the right to use any photograph/video taken at any event hosted by PWSA Vic, without the expressed written permission of those included within the photograph/video. PWSA Vic may use the photograph/video in publications or other media material produced, used or contracted by PWSA Vic including but not limited to: brochures, invitations, booklets, newspaper articles, social media publications, email notifications, websites, etc.

To ensure the privacy of individuals and children, images will not be identified using full names or personal identifying information without written approval from the photographed subject, parent or legal guardian

However, a person attending a PWSA Vic event who does not wish to have their image recorded for distribution should, prior to the event, make their wishes known to the event organiser or the President of the PWSA Vic at info@pwsavic.org.au in writing of his/her request and include a photograph. PWSA Vic will use the photo for identification purposes and will hold it in confidence.

By participating in a PWSA Vic event or by failing to notify PWSA Vic, in writing, your desire to not have your photograph used by PWSA Vic, prior to the event you are agreeing to release, defend, hold harmless and indemnify PWSA Vic from any and all claims involving the use of your picture or likeness.

Any person or organisation not affiliated with PWSA Vic may not use, copy, alter or modify PWSA Vic photographs, graphics, videography or other, similar reproductions or recordings without the advance written permission of an authorised designee from PWSA Vic.

Thank you for your understanding and cooperation.
Please tick*

I have read and understood the above disclaimer and agree to the terms as outlined
Signature*

Clear
Use your mouse or finger to sign

Meal planning, activities and accomodation
Organising an event like the PWS Time Out camp is both time-consuming and costly. While the PWSA Vic is pleased to heavily subsidise the camp costs for our members' benefit, it is disheartening to see resources go to waste.
- Meals: We are engaging caterers to prepare our meals, and we need to know if you will not require a meal so that it isn’t unnecessarily paid for.
- Volunteers: Ensuring we have enough volunteers is always challenging, so we are enlisting the Camp staff to help run our activities. This necessitates careful planning to maintain the correct ratio of trained staff to participants.
- Participant Count: When completing our final paperwork, we must submit an accurate account of who will be on the Camp premises at all times.
While we encourage everyone to attend the entire camp to have fun, relax and unwind, we understand that this is not always possible. Please provide details below for any participants who will be arriving late, leaving early, or not staying overnight, as well as their meal and snack time attendance.

We appreciate your cooperation and understand that unforseen emergencies may arise.
Will all the participants registered be attending for all the meals for the duration of the camp? ( The first meal of the camp will be Friday evening at 5:00pm and the last meal of the camp will be at ......)

YesNo
Please outline the attendance details of the above registered participants NOT attending the whole camp.

MORE INFORMATION:
More information will be emailed to the applicant closer to the camp date. Details will include directions, what to bring with you, the Full Camp Program, and details of the Camp Menu.

If you have any questions, comments or suggestion please contact Kurstie Jenkins on 0403337457 or write in the feedback space below.
Feedback

PAYMENT:
Fee
This is the figure you have agreed to pay at the time of this registration
Donation:
Donations of $2 or more are tax deductable
Total
Secure online payment.

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Do you require an official invoice or a receipt to submit a claim to NDIS before payment? Note: Payment is due 7 days from the date of registration regardless of whether NDIS funds are utilised to pay for camp or not.

Please send me an official invoice for NDIS. I have not yet made a payment.Please send me an official receipt to apply for reimbursement from NDIS. I have made a payment above.
Main Contact Person:*

First NameLast Name
Please send all emails relating to this camp to:*
Should be Empty:

2024 TIME OUT CAMP

CALCULATING THE FEES

Parent/Carer attendance

DETAILS OF THE PERSON LIVING WITH PWS ATTENDING:

DETAILS OF OTHER ATTENDEES:

DETAILS OF OTHER ATTENDEES:

DETAILS OF OTHER ATTENDEES:

DETAILS OF OTHER ATTENDEES:

DIETARY INFORMATION:

MEDICAL INFORMATION:

DETAILS OF EMERGENCY CONTACT/S:

PRIVACY STATEMENT:

TERMS AND CONDITIONS:

CONSENT TO PHOTOGRAPHY/VIDEOGRAPHY:

Meal planning, activities and accomodation

MORE INFORMATION:

PAYMENT: