Summer Camp 2025

SUMMER CAMP 2025

To register for Youth Camp, 21-24 Jan 2025, please complete the form below (to be completed by Parent/Guardian if under 18)
Youth Full Name*

First NameLast Name
D.O.B.*

DayMonthYear
Gender*
Please Select
E-mail*
example@example.com
Address*

Street Address

Street Address 2

SuburbState

Postal CodeCountry
Phone Number*
School Grade in 2025*
Church*
If you are attending Youth Camp with a friend, please include their name here.
Medical Details
Any known medical or physical conditions, incl Allergies, medications*
Please type 'Nil Known' or 'NA' if not applicable
Dietary Requirements*
Please type 'Nil Known' or 'NA' if not applicable
Emergency Contact Name*
Emergency Contact Number*
Indemnity Release
I/We understand that C3 Church Adelaide Hills (the Church) will take reasonable steps to provide a safe environment for my child and to ensure that all equipment supplied by them for activities are of a reasonable standard.

I/We acknowledge that the Church will not be liable for any injury that may be suffered by my child, which arises either directly or indirectly from, or in connection with an activity at the youth camp.

I/We hereby agree to indemnify the Church against any and all claims arising from, or in connection with, any injury that may be suffered by my child, or that my child may cause to another person, as well as any loss or damage to property, equipment or personal effects belonging to my child, or any other person, arising directly or indirectly out of or in connection with any activities performed at a the youth camp.

I/We agree that the Church may authorise on my child’s behalf whatever medical treatment he/she may require. (This includes, but is not limited to, ambulance attendance and hospital treatment) I/We agree to pay all medical expenses incurred.
Confirmation*

I confirm that the information I have supplied on this form is true and correct to the best of my knowledge.
Indemnity*

I agree to the indemnity release terms stated above
C3 Youth take video and photographs of various activities at Camp that contain Children, which may be used on Social Media, our Website or other public media. Please indicate below that you consent for images of your child/ren to be published in these formats.
Image Consent*

I give permission for photos of my child/ren to be published as indicated above.I DO NOT give permission for photos of my child/ren to be published as indicated above.
Parent / Guardian Full Name*

First NameLast Name
Today's Date*

DayMonthYear
Phone Number*
Registration & Payment

My Products*

SUMMER CAMP EARLY BIRDENDS 15TH DECEMBER

$160.00AUD

SUMMER CAMP FULL REGO

$195.00AUD

Enter coupon

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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SUMMER CAMP 2025

Medical Details

Indemnity Release

Registration & Payment