Camp Attendee Registration Form

October Midterm Camp Registration
Attendee Details
Full Name*

First NameLast Name
Preferred Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth of attendee*

DayMonthYear
Date
Group*

Early Birds 0-5 yearsMini Buddies 6-10 yearsBuddies 11-15 yearsFocus 16+ years
Attendee diagnosis / pending diagnosis / Specific needs*
What triggers or dislikes does the attendee have that we should be aware of?
How can we best support the attendee?
What likes or motivators does the attendee have that we should be aware of?
What toileting requirements does the attendee have, if any?
Medical requirements of ALLERGIES
Mobility requirements
Photograph of attendee*

Cancelof
Please upload any images / PECS that may support the attendee

Cancelof
Attendee communication - Please detail the spoken / understood languages or communication methods used by the attendee
Please use this space to inform us of any further information which will help staff to work along side the attendee i.e. useful information, advice for particular situations, particular routines, etc...

Emergency Contracts - Persons to contact in case of an emergency

	Full Name	Relation	Contract Number	Address
1
2
3

The cost of October Midterm Camp is £60 for 1 attendee or £90 for 2 attendees (this is applicable to sibling pairs). This payment price covers Camp attendance regardless of days attended and is non-refundable.

You must upload a copy of your payment confirmation, in the upload box below, to secure Camp attendance.

Please note, PossAbilities Members are eligible to attend Camp at a discounted rate of £50 for 1 attendee or £80 for 2 attendees (this is applicable to sibling pairs) until registration closing date (17th October).

If attendees (siblings in groups of larger than 2 attendees) will also have access to group rates, please email us at info@possabilities.gi for further information.

Thank you!
Please upload a copy of your payment receipt.*

Cancelof
Please select the days of intended attendance for the attendee, below. Payment will be required latest 3 days before commencement. PossAbilities will try to support and accomondate as best as possible however cannot commit to securing positions for attendees on days not selected, that are chosen at a later date, after closing date of camp applications.
Days attending

27th October28th October29th October30th October31st October
Name of person (parent/guardian) completing this application*

First NameLast Name
Email*
example@example.com
Mobile number*
I hereby agree and declare that I am the legal parent guardian (and have permissions as such) of the above-named attendee (“the attendee”) and hereby consent to the attendee's participation in PossAbilities Summer Camp ("camp") and hereby agree and declare that I understand the scope of the sessions. I understand that some of the activities to be undertaken during the sessions may be of the kind which may result in, however unlikely, physical injury to the attendee but nonetheless specifically request that they be allowed to participate in said sessions.

If the attendee requires any first aid, non-emergency or emergency medical treatment or procedures during the sessions, I hereby consent to PossAbilities Limited’s staff to make any decision and take any action necessary to arrange for such procedures or treatments at the discretion of sessions staff and acknowledge that PossAbilities Limited will make all reasonable attempts to contact me but if this is not possible, I confirm that PossAbilities Limited is authorised to act on our behalf to make any necessary first aid, non-emergency or emergency medical treatment / decision.

In consideration of my application and permitting the attendee to participate in the sessions, I hereby agree to WAIVE, RELEASE, AND DISCHARGE PossAbilities Limited and its directors, officers and employees from any cause of action, claims or demands now or in the future and from any and all liability arising from or in connection with the sessions for any injury or consequence, property damage, property theft, property loss or actions of any kind which may occur to the attendee during the sessions, including during any activities.

I hereby agree for the attendee's data to be held in line with data protection laws and regulations, as per PossAbilities policies. I agree that the attendees progress and details may be discussed with professionals and consultants, in relation to their particiaption of camp, always in the best interest of the child attending.
Please select the following:

I consent to the attendee participating in all off-site activities including travelling in PossAbilities organised transportI consent to PossAbilities to allow its staff and any agents to take photographs and videos of my child and give permission for said photos and videos to be used by PossAbilities in connection with any publicity material including publishing of said content, photos and videos on PossAbilities' social media platforms and for any other PossAbilities Charity marketing purposesIn the event I forget to pack snacks for the attendee, I consent and give permission to PossAbilities' staff to give the attendee any snacks supplied by PossAbilities (in line with their dietary requirements [if any])
By signing below, you are signing that you confirm the above agreements, all information here in is deemed as correct to the best of your knowledge and you are the attendee or the parent or legal guardian, signing on behalf of, the attendee.

Powered by Jotform SignClear
Should be Empty:

October Midterm Camp Registration

Attendee Details