INTERNATIONAL CAMPER - United Youth Camp Australia 2025 Application
2025 United Youth Camp Australia - International Camper Application, Medical and Consent Form
Name
First Name
Last Name
Date of Birth
Age
Gender
Male
Female
Mothers Full Name
First Name
Last Name
Mothers Phone Number
Mothers Email Address
example@example.com
Fathers Full Name
First Name
Last Name
Fathers Phone
Fathers Email Address
example@example.com
Emergency Contact Name (Other than Mother and Father)
First Name
Last Name
Emergency Contact Phone Number
Emergency Contact Email
Address of Applicant
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Local Congregation
UCG Minister/Pastor
If no UCG Pastor write N/A
UCG Minister/Pastor Email
example@example.com - If no UCG Pastor, leave blank
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Health
Does the applicant (camper) have any allergies?
Yes
No
If you selected Yes, please provide more details
Include the name of allergy, type of reaction and treatment
Does the applicant (camper) have any dietary requirements?
Yes
No
If you selected Yes, please provide more details
Does the applicant (camper) have any medical/childhood conditions
Yes
No
If you selected Yes, please provide more details below
Please include the name of the condition, if you have a management plan, and treatment
Medical Action Plan
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If you have a medical action plan including but not limited to Asthma Action Plans and Epilepsy management plans please upload it here or send it to stephenclark@ucg.org.au
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Medications
Name of Medication
Dose
Morning
Midday
Afternoon
Evening
As needed
Comments
Medictaion 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6
Private Healthcare Provider
Private Healthcare Membership Number
Family Doctor
Family Doctors Phone Number
Has your child been admitted to hospital in the last 12 months
Yes
No
If you selected 'Yes' please provide more details
It's important for our first aid officers to be aware of any medical conditions, recent surgeries, or investigations that could impact your child's safety while they are away. All information is voluntary.
Has your child had any of the below vaccines
Combined Diphtheria Tetanus Pertussis Booster injection
Measles
N/A
Travel Insurance Information
Important: All international applicants must have Travel Insurance as a pre-requisite for attending UYC-A.The Travel Insurance must include full medical/hospital cover.
Travel Insurance Company
Policy or Group no.
Type of Policy with Inclusions (e.g. Comprehensive; Health; Accident; Other)
Travel Insurance Policy Document Upload
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Insurance Company Address
Insurance Company Phone Number
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General Camp Questions
What is the applicants (campers) swimming ability
Non-swimmer (does not know how to swim)
Beginner (can tread water or lie on back, but cannot swim a distance)
Intermediate (can swim 25+ metres unaided)
Advanced (can swim 50+ metres unaided)
T-Shirts: UYC T-shirts may be purchased by campers. Cash payments will be accepted at Camp. Please do not make payment with your camper fee payment (you are not required to make a payment in this form).Please indicate the size and quantity you wish to purchase on your application form.Be aware that T-shirt sizes tend to be large.
Categories:
All
All
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( X )
What musical instrument/s does your child play? If none, type N/A
Do you give permission for photographs of your child/ward taken during camp to be included in:
All United Church of God Publications and Websites
United Youth Camp Newspaper and DVD/video
Both
Neither
Terms and Conditions
Parents/Guardians must read and accept the following terms and conditions. HEALTH: As the parent/legal guardian of the applicant, I assume full responsibility for his/her health, being such that activities undertaken during the camp will in no way aggravate any existing medical condition. If in any doubt, medical advice will be sought and followed, and the Camp Director will be informed. I will also notify the Camp Director immediately should there be any changes to my child/ward’s health status prior to the program and their participation in the activity. In the case of a medical emergency, I hereby give permission to the doctor chosen by the Camp Director to secure proper treatment for and/or order hospitalisation, injection, anaesthetic, or surgery for my child/ward. I understand every effort will be made to contact me prior to instituting such procedures. I agree to incur any additional expenses associated with such action. ACCEPTANCE OF RISK AND RESPONSIBILITY: As parent/legal guardian, I am aware that during my child/ward’s participation in camp and associated activities as arranged by United Youth Camp – Australia, its management, employees or any person acting on their behalf, certain risks or dangers may occur. I understand that participation at camp is not without some risk and that I as a parent/guardian must be willing to assume that risk. I accept all the inherent risks of my child/ward attending camp and the possibility of personal injury, loss or personal property damage resulting from participation in the camp and its associated activities. I understand that United Youth Camps – Australia, its management, employees, or any person action on their behalf, will take all reasonable care for the welfare and safety of those attending the camp but are not responsible for any accident or sickness otherwise occurring. I acknowledge that going on camp may involve my child/ward’s participation in activities of a hazardous nature, though United Youth Camp – Australia and its employees will take all reasonable care to minimise risk to participants. By submitting this form I indicate my willingness to permit my child/ward to participate fully in all activities associated with the proposed camp/excursion, including (but not limited to) those described by the Camp Director for the United Youth Camp – Australia as indicated in literature and/or oral presentation. The submission of this form also indicates that my child/ward understands and agrees to uphold the guidelines and standards of the camp as outlined in supporting information and as presented by the Camp Director, employees or any person acting on behalf of the United Youth Camp – Australia. I agree that I have read this document and that I fully understand all the information presented and the risks involved. I declare that all statements on this form are true and accurate, and that all relevant information has been provided.
Submitting this form acts as an electronic signature. By submitting this form you agree to the Terms and Conditions.
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