Camp Registration Form

Camp Registration

ABN: 55 637 079 620
Type of Camp*

Kool Kids School Holiday Self-Esteem CampsASD (Autism Self-Esteem) Weekend CampsBoys to Men Weekend CampsGirl Pampering Weekend Camps
Choose your Groups*

Pre-TeensTeensSchool LeaversYoung Adults
Choose your school holiday dates*

January 14-16 2026April 15-17 2026July 8-10 2026September 30 - October 2 2026
Choose your ASD Weeks*

Week 1 - Mental Development (February 6-8)Week 2 - Physical Development (February 27 - March 1)Week 3 - Emotional Development (March 20-22)Week 4 - Life Skills (April 17-19)Week 5 - Advanced Social Dynamics & Teamwork (May 15-17)Week 6 - Independence & Real-World Readiness (June 5-7)Week 7 - Confidence Through Creativity & Expression (June 26-28)Week 8 - Resilience & Problem-Solving Under Pressure (July 17-19)Week 9 - Leadership & Celebration (August 7-9)
Choose your Girl Pampering Weeks*

Week 1 - Understanding changes in the female body (February 13-15)Week 2 - Hygiene and grooming (March 6-8)Week 3 - Friendships and relationships (March 27-29)Week 4 - Manners and table etiquette (May 1-3)Week 5 - Self-respect and confidence building (May 22-24)Week 6 - Self-awareness (June 12-14)Week 7 - Getting started on life trajectory (July 3-5)Week 8 - Life skillstools (July 24-26)Week 9 - Empowerment through pampering (August 14-16)
Choose your Boys to Men Weeks*

Week 1 - Physical Development (February 20-22)Week 2 - Emotional Awareness (March 13-15)Week 3 - Mental Growth (April 10-12)Week 4 - Social Skills and Relationships (May 8-10)Week 5 - Self-Respect and Confidence Building (May 29-31)Week 6 - Life Skills for Success (June 19-21)Week 7 - Empowerment Through Action (July 10-12)Week 8 - Stepping Up as Leaders and Role Models (July 31 - August 2)Week 9 - Finding Your Voice, Building Connections (August 21-23)
Participants Name*

First NameLast Name
Gender*

MaleFemaleNon Binary
Date of Birth*

MonthDayYear
Date
Residential Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Medical Health Details
Medicare Number*
Medicare Expiry Date*

MonthDayYear
Date
Private Health Insurance (If Applicable)
Private Health Insurance Provider
Private Health Insurance Number
Parent/Guardian Information
Name*

First NameLast Name
E-mail*
example@example.com
Mobile Number*
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Mobile Number*
Alt. Mobile Number
Add another emergency contact

YesNo
Emergency Contact's Name

First NameLast Name
Relationship
Mobile Number
Alt. Mobile Number

Are there any behavioural or medical conditions which we should be aware of? If the condition is not mentioned below, please state in the additional notes section below.

	Yes	No
ADD/ADHD
Autism Spectrum Disorder
Hearing/Sight Impairment
Formal Counselling, Depression or other issues that may affect the participant on the event?
Is there any restriction on activities?
Bed Wetting
Sleep Walking
Travel Sickness

Additional Notes/Other:
Swimming Ability*

DIETARY AND FOOD INFORMATION
Dietary Requirements

VeganVegetarianGluten FreeDairy FreeFood AllergiesOther
First Night Meal Choice (Dinner)
Please choose from the following: (Please choose one only)*
Food and Drink Allergies within these Meal Choices
Second Night Meal Choice (Dinner)
Please choose from the following: (Please choose one only)*
Food and Drink Allergies within these Meal Choices

Consent Form
Media Consent

Students’/participants' images and/or their work are often published to recognise excellence or effort and may appear in newspapers, on the internet, in newsletters or on film/video. Their names may also be included but no contact details are provided. Work/images captured by Kool Kids Tutoring will be kept for no longer than is necessary for the purposes outlined above and will be stored and disposed of securely.
Please check one of the following:*

Yes, I give consent to my child to have his/her image and/or work published as described above.No, I do not give consent.
Food Consent

During lessons and activities, students/participants may be given light snacks/lunches (e.g. sandwich and a popper).
Please check one of the following:*

Yes, I give consent to Empowered Therapy & Training to provide light snacks/lunches as described above during activities/lessons provided that they are not food items that my child is allergic to or has a dietary restriction against please specify any allergies/dietary restrictions below)No, I do not give consent.
Food Allergies:
Dietary Restrictions:
Travel Consent

During lessons and activities, students/participants may be given light snacks/lunches (e.g. sandwich and a popper).
Please check one of the following:*

Yes, I give consent to Kool Kids Tutoring to pick up/drop off my child from venues specified by me.No, I do not give consent.
Name*

First NameLast Name
Date Signed:*

MonthDayYear
Date
Parent Signature:*

Clear

Request to Administer Medication on Camp (Nationwide Form)
Please provide a list of all medications required to be administered whilst on camp.

Medication Administration Details

	Name of medication	Dosage (eg 5mg/5ml)	Route (eg oral,eye drop,topical)	Time/s to be given on camp?	Reasons for administration, instructions. Eg with food, before bed etc
Type here:
Type here:
Type here:
Type here:
Type here:
Type here:
Type here:

PAYMENT AND FUNDING
Are you?*

NDIS CamperPrivate Camper
NDIS Number*
Payment Options*

Debit or Credit CardPayPal CheckoutEway (After Pay)Ezpay (Installment Payments)
Invoice to:

This is the informations we should send invoices to
Name*

First NameLast Name
Organisation Name:
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Eway (After Pay)

Kool Kids Self-Esteem Camps

$1,399.00AUD Quantity

Weekend Camps

$1,399.00AUD Quantity

Subtotal

$0.00AUD

Tax

$0.00AUD

Total

$0.00AUD

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Camp Registration

Medical Health Details

Private Health Insurance (If Applicable)

DIETARY AND FOOD INFORMATION

First Night Meal Choice (Dinner)

Second Night Meal Choice (Dinner)

Consent Form

Media Consent

Food Consent

Travel Consent

Request to Administer Medication on Camp (Nationwide Form)

Please provide a list of all medications required to be administered whilst on camp.

PAYMENT AND FUNDING

Invoice to: