April 2026 Holiday Camp Registration Form

Autumn Adventure Camp Registration Form

12-17 April 2026 These forms are required for your children to attend camp.
Who is the person filling in this registration?*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
ParentCaregiverSocial WorkerOther

Emergency Contacts/Authorized Pickup

The parent or guardian listed in the previous section CANNOT be listed as an emergency contacts. List the names of two people who can be contacted in the event of an emergency or illness if the parent/guardian cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the camp, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
Emergency Contact
Emergency Contact #1*

First NameLast Name
Contact #1 Phone Number*

Area CodePhone Number
Emergency Contact #2*

First NameLast Name
Contact #2 Phone Number*

Area CodePhone Number
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.

Billing Details

The camp costs $260.00/child or $240.00/child if two or more attend from the same family. Fees can be paid by instalments prior, please email bookings@chosenvalley.org.nz to arrange this. Otherwise please pay upon receipt of your invoice. Full payment is required before camp begins. Please note that we have no Credit Card or EFTPOS facilities
I will pay via bank deposit - an invoice will be emailed to youI qualify for a subsidy
YesNo
YesNo
Total number of children you are registering*
Billing Name*
Name of the person or organization paying
Billing Email Address*
Email of the person receiving the invoice
No - please note all billing through Oranga Tamariki requires a purchase orderYes - I will ensure that this is emailed to bookings@chosenvalley.org.nz

Terms and Conditions of Booking

Camper Agreement
I have made my child(ren) aware of the Camp Rules & Agreement. They will sign on arrival at camp.
Camp Rules and Camper Agreement
We want to make sure that everyone who comes to camp has the best time. We have rules that everyone has to follow. Please read these and sign your name to show you agree to follow them.
1. I will follow all safety signs: Go, Wait, Stop.
2. I will not play with fire hoses, fire alarms or extinguishes.
3. I will not go into other cabins belonging to the opposite gender.
4. As a camper I will stay with my team and follow the instructions given by my leaders.
5. I will not swap teams / dorms.
6. I will not take food and drink into the dorms.
7. I understand that bullying, teasing or name calling will not be tolerated (This may result in me being sent home).
8. I understand fighting and violence will result in myself, the camper, being sent home.
9. I understand that there is no inappropriate physical contact at camp.
10. I will not go in areas that are out of bounds except in an emergency, this includes:
- The main road and car park
- Staff houses and surrounding gardens and driveways
- Workshop and storage areas
- The pond area without your leader

Terms and Conditions of Booking

Parents Agreement
Please read the below information
I give my permission to use photos/videos of my child for promotional purposesI DO NOT give my permission to use photos/videos of my child for promotional purposes
You will need to scroll through and read the conditions below to enable the permission checkbox.
Parent / Guardian Signature*

Clear
Date Signed*

DayMonthYear

Autumn Adventure Camp Registration Form