School Holiday Camp Jan 19 - 23, 2026 Registration Form

  • Camp Registration Form - School Holiday Camp January 19 to 23, 2026

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Camp Attending
  • Camp Start Date
     - -
  • Camp End Date
     - -
  • Gender
  • Are you?
  • Do you require an interpreter?
  • How is the camp going to be funded?
  • If you are NDIS funded are you;
  • Does the camper have a court order?
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  • Does the camper have any of the following?
  • Does camper take regular medication?
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  • Do you give permission for the camper to receive first aid and other medical treatment if necessary during the camp?
  • Does the camper have any behaviours or challenges we should know about?
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  • Family Information

  • Relationship to Camper
  • Format: (000) 000-0000.

  • Emergency Contact Information

  • Format: (000) 000-0000.

  • Photography/Media Consent and Risk Waiver

  • I do/do not consent to A and D Child and Family Support using photographs of me/my child for life story purposes only. A and D Child and Family Support will provide copies of all photographs taken at the conclusion of the camp on a USB.
  • I do/do not consent to A and D Child and Family Support sharing information with other services:
  • In consideration of being allowed to participate in camp activities, I, on behalf of myself (or my minor child), hereby waive, release, and hold harmless  A and D In Home Care, its employees, volunteers, and affiliates from any and all liability, claims, or causes of action for personal injury, illness, property damage, or wrongful death resulting from participation in camp activities, whether caused by negligence or otherwise.

  • Swimming Consent

  • I agree for my child to participate in swimming activities whilst in the care of A and D Child and Family Support.  By signing this consent, I acknowledge and understand the risks involved in swimming and would consider my child to be a:

  • Terms and Conditions

    1. I accept that sending booking request, a tax invoice will be generated and sent to my email address.
    2. I accept that it is my responsiblity to ensure that payment is made in advance to the camp.
    3. I agree for A and D staff to be in chanrge of my child and understand they have a duty of care to always supervise them while on camp.
    4. I accept that all staff from A and D will be in procession of my childs medication and emergency response plan and will be responsible to ensure all medication is provided as describe.
    5. I acknowledge that I want to attend the camp and will abide by all policies at the A and D In Home Care camp.
    6. I have signed all of the documentation.
    7. I note that payment is required within 14 days of camp attendance.
    8. I accept that 14 days notice must be provided of non attendance or payment in full will be charged.

    Submission of this form is also considered acceptance of these terms and conditions. 

  • Upon receipt of this form, A and D Child and Family Support will email confirmation to the email address provided and will forward any additional forms that are required for the camp.

  • If you have any questions or would like any further information please contact:

    KATHRYN MINOGUE

    PROGRAM CO-ORDINATOR

    A AND D CHILD AND FAMILY SUPPORT

    PH: 0482 472 481

    EMAIL: kminogue@aanddinhomecare.com.au

  • PRIVACY STATEMENT

    We will not disclose your personal information to any other third party unless you have given consent or we are required by law.

    You can request access to your personal information at any time. Please contact administration staff at A and D to do so.

     

  • PAYMENT

    A and D In Home Care
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      Camp Registration Fees - School Holiday Camp
      $1,650.00AUD
        
      Total
      $0.00AUD

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