2027 TMC South Enrolment

Camper's Name

First NameLast Name

Gender

Birth Date

DayMonthYear

Parent/Caregiver's Email

example@example.com

Parent/Caregiver's Phone Number

Camper's Email (if applicable)

example@example.com

Camper's Phone Number (if applicable)

Who should the invoice for camp be sent to?

Other

Camper's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

DIFFERENT - Emergency Contact Information

It is important we have a DIFFERENT second person who will be contacted only if we are unsuccessful in our attempts to contact the parents/caregivers listed above.

Emergency Contact's Name

First NameLast Name

Relationship

Emergency Contact's Primary Phone Number

Secondary Phone Number (if applicable)

Swimming Ability

Some of our camps may include swimming and/or water based activities. It is important our staff know the level of swimming ability to safely plan these activities.

Swimming Ability

Transport

How will the camper be arriving at camp?

Name of Bus Company

Location of Pick Up

Arrival Time

Date

Hour MinutesAM/PM Option

Name of Bus Company

Location of Drop Off

Departure Time

Date

Hour MinutesAM/PM Option

UNDER 16 ONLY - Parents authorised to collect camper

If the camper is 16 or older, they may sign themselves in and out of camp. Write N/A if camper is over 16

Special Diets

If this is for medical reasons (such as anaphylaxis, food allergies, eczema, or other diagnosed conditions), please provide full details, including any relevant treatment or management plans. It is essential that our kitchen staff are aware of all serious food allergies and the appropriate steps to take in the event of a reaction.
This information helps us ensure the safety and wellbeing of all campers.
Please note that we are generally unable to cater for dietary requirements based on lifestyle preferences where this requires separate meal preparation (feel free to get in touch with us).

Please Specify any Dietary Requirements

Please describe here

Dietary Requirements Surcharge

To help cover the additional cost and preparation involved in providing special dietary meals (such as coeliac, gluten-free, or dairy-free), a surcharge of approximately $25.00 may apply.
This surcharge may be waived if caregivers are able to provide suitable food or meals for the camper.
In some cases, additional camp fee credit may also be available for families supplying larger quantities of food for specialised diets.
CYC can provide a weekly menu plan to help caregivers prepare similar meals, allowing campers to feel more comfortable and included during camp.
For more information about dietary options after enrolment, please contact the CYC office at kidscamps@cycwaihola.org.nz.

Health Information

Does the camper have any health concerns?

Health Notes for CYC Staff (confidential):

Will the camper require any medication during camp? This includes EpiPens

Rows	Medication Name (e.g. Melatonin)	When Needed (e.g. Evening)	Dose (e.g. 1 x 2mg tab)	Reason (e.g. Needed for sleep)
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6
Medication 7
Medication 8
Medication 9
Medication 10

Do you give permission for CYC staff to give paracetamol in recommended doses if required?

Doctor's Name

First NameLast Name

Medical Centre

Medical Centre Phone

Area CodePhone Number

Does the camper have any behavioural issues, or any previous/current struggles that may present at camp? Please list in "enrolment information" if so

Other Enrolment Information

Other Enrolment Information or Comments - Include any additional information relevant to your camper’s enrolment

Please note: Cabin requests cannot be changed within 7 days of camp start date.

Important note: if there is a parenting order, protection order, or other court order/agreement, please submit a copy of this order to CYC Waihola so a safety plan can be discussed with you and generated.

How did you hear about this camp?

Which school does the camper attend?

If you attend a church, please write which one below

Make donation receipt out to:

First NameLast Name

Enter donation amount here:

Payment Terms for Camp Fees

Camp Fee Payment & Refund Policy

Upon successful enrolment in a camp, you will receive an invoice by email for the camp fees. Campers placed on the waiting list will not receive an invoice unless a place becomes available.
A non-refundable deposit is required to secure all enrolments. The deposit for this camp is $100.
Credit card payments can only be made once an invoice has been issued and cannot be processed at the time of enrolment.
If an enrolment is cancelled more than 7 days before the camp start date, a refund of camp fees paid (excluding the non-refundable deposit) will be provided.
If an enrolment is cancelled less than 7 days before the camp start date, no refund will be available (unless for medical reasons)
If full payment has not been made prior to the start date, the camper cannot attend (unless a prior payment agreement has been made with manager@cycwaihola.org.nz)

How do you wish to pay for camp fees?

PLEASE READ IN FULL BEFORE SUBMITTING YOUR ENROLMENT

Terms and Conditions of Attendance at CYC Waihola Camps

General Conditions

These terms and conditions may be updated at any time, but CYC Waihola MUST be made aware of any changes in writing.
All enrolment information is correct to the best of my knowledge
I understand this information is used for the safe operation of camps and for possible follow-up contact after camp
I consent to photos and video of the camper being used for CYC Waihola promotional purposes without remuneration

Medical and Health Conditions

Campers cannot attend if they have had any of the following within 72 hours prior to arrival:

Symptoms of illness, including cold or flu-like symptoms (such as runny nose, cough, sore throat, fever, vomiting, or diarrhoea)
Close contact with anyone showing symptoms of illness
A concussion or head injury within 3 weeks of camp start date

A full refund will apply if CYC Waihola is notified in advance.

Medical authorisation

I authorise camp staff to administer basic first aid and approved medication as required
I authorise camp staff to seek urgent medical treatment if necessary (at my cost)

Behavioural Conditions

Campers may only be contacted during camp in an emergency unless otherwise arranged with the CYC Office
If a camper becomes unwell, disruptive, or unable to cope, parents or caregivers will be contacted
Campers may be sent home at the caregiver's expense if behaviour is unsafe, disruptive, or results in damage to property
No refunds will be issued in these cases, and future enrolments may be declined

Camp Programme Conditions

Camp programmes include Bible-based teaching presented in an age-appropriate way to encourage positive values and personal growth
Prayer may be included in activities and mealtimes
Camp activities may include elements of risk and are managed under CYC Waihola safety procedures by trained staff
Activities may be modified, postponed, or cancelled at any time for safety reasons
Activities may include (but are not limited to) archery, air rifles, archery tag, bubble soccer, go-karts, horse riding, paintball, tramping, and zip-lining
I consent to the camper participating in all camp activities and travelling off-site as part of the camp programme

Payment and Refund Terms

A $100 non-refundable deposit is required to confirm enrolment unless otherwise arranged in writing with the CYC Waihola office (including approved subsidies). Full payment must be received before camp attendance.

Your Privacy

CYC Waihola collects and holds personal information (including health and medical information) provided on this form in order to safely run camps, provide follow-up contact, and meet legal obligations, in line with our Privacy Policy.

Access to your information is restricted to CYC Waihola staff who need it to run the camp safely — principally the Camp Director, relevant camp staff, and the Privacy Officer (Operations Manager) — and is not used for any other purpose without your consent, except where the law requires or allows it.
You (or, for a camper under 16, their parent or legal guardian) have the right to request access to, and correction of, any personal information CYC Waihola holds about you or your camper. Requests can be made to the Privacy Officer via the CYC Waihola office.
You have the right to bring an advocate or support person of your choice to any meeting or discussion with CYC Waihola about your enrolment, a concern, or a complaint.
Full details of how your information is collected, used, stored, and disposed of are available in our Privacy Policy, available on request from the CYC Waihola office.

Agreement

By submitting this form, I confirm I am the parent or legal guardian of the camper and agree to these Terms and Conditions in full.

Feedback and Complaints

We welcome your feedback, and want to know if something hasn't gone as it should. You may share feedback or make a complaint at any time, in whatever way is easiest for you:

Online: https://form.jotform.com/242736440200849
In writing or in person to the CYC Waihola office
By speaking with the Camp Director or Operations Manager directly

You're welcome to bring an advocate or support person of your choice when raising feedback or a complaint. All complaints will be acknowledged and responded to in a reasonable timeframe.

A printed copy of our policies are available for your review onsite.

CAMPER/CAREGIVER INFORMATION

EMERGENCY CONTACTS

SWIMMING & TRANSPORT

MEDICATION INFORMATION

MEDICATION DOSAGE CHART