• 2015 Summit Camps Registration Form

  • Details of Camper #1

  • Select Camp*
  • Year at School in 2015*

  • IF JUST THE ONE CHILD FROM YOUR FAMILY IS REGISTERING PLEASE GO TO THE END OF THE FORM TO VIEW THE WAIVERS AND SUBMIT BUTTON. 

    If more children to register please continue, if more than 3 from one family please submit 3 from this form and start a new form for additional children.

  • Details of Camper #2 (from same family)

  • Select Camp
  • Year at School in 2015

  • Details of Camper #3 (from same family)

  • Select Camp
  • Year at School in 2015

  • Waivers and Submit Form

  • I, the above Parent or Caregive give consent to photos of my child/children being using for future promotional purposes.

  • The leaders and organisers are giving of their time freely and have the safety of your children foremost in any activity. However, due to the nature of sports and the physical activities typical of summer camps we need to obtain a waiver from parents as follows.

  • Informed Consent and Acknowledgement

    I, the above-named Parent or Caregiver, hereby give my approval for my child/children to participate in all activities prepared by Summit Camps. I therefore accept the risks and hazards incidental to the conduct of the activities, and do not hold Summit Camps as an organisation liable for any injuries to my child/children arising from any activities during camp. This extends to the camp supervisors, parent helpers and managers or owners of the campsite itself, as well as the personel who run specific activities on behalf of Summit Camps at Kokako Lodge and Hunua Falls Camp.

    Medical Release and Authorization

    As Parent or Caregiver of the named child/children, I hereby authorize the diagnosis and treatment by a qualified medical professional in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention.

    Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

    Permission is also granted to Summit Camps and its supervisers and parent helpers to provide the needed emergency treatment prior to the child’s admission to the medical facility.

    This permission is valid for the dates of the Summit Camps from January 11-15 2015.

  • BY TICKING THE BOXES BELOW AND THEN CLICKING ON THE SUBMIT BUTTON I ACKNOWLEDGE THAT I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS A WRITTEN SIGNATURE.

  • I, the above named parent or caregiver, have read and accept the following terms as detailed above.
  • Should be Empty: