SSAM Family Camp Form 2022

SSAM Family Camp Form 2022

06/12/2021
WHEN:

Arrival: Saturday, 1st January at 3:00pm

Return:Monday, 3rd January at 2:00pm

WHERE:

Phillip Island Adventure Resort 1775-1801 Phillip island road, Cowes VIC 3922

RSVP:

Completing this consent form by Friday 17th December.

WHO:

Grade 1 - Grade 6

PRICE:

$150 per child

$200 per adult

BRING:

Clothing for all seasons

Notepad and pens

Bible

Sleeping gear

Swimming attire

Toiletries

2 Towels

Thongs

DO NOT BRING:

Phones

Ipad

Contact Number:

Nashat- 0401 687 656

Please note that you are responsible for picking up your child during the camp if you are contacted via phone and advised to do so by a sunday school teacher.
Childs Full Name:*

First NameLast Name
DOB*

DayMonthYear
Date
Age:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Emergency Contact Name:*

First NameLast Name
Relationship:*
Phone Number of Emergency Contact:*

Area CodePhone Number
Medical Report
Please tick if your child suffers from any of the following:

Heart conditionTravel sicknessAsthmaSleep WalkingMigrainesBlackoutsOther
Food/other allergies:
Medication (name & dosage):
Dietary requirements:

VegetarianVeganGluten FreeCoeliacLactose FreeOther
If your child does NOT attend COR KIDS regularly, how did they hear about this camp?
Any other concerns or requests?
I give permission for my child to attend SSAM Family Camp 2022 and for the following:
- I authorize any leader of COR KIDS group to authorize and arrange any medical treatment/intervention required by my child/myself as deemed necessary during the course of the camp. Furthermore, I authorize any leader of COR KIDS group to use an ambulance or any other medical service deemed necessary. I accept responsibility for all expenses associated with any/all medical treatment.
- I agree to indemnify and hold harmless COR KIDS group from and against any and all claims, demands, suits and liability of any nature however arising out of any activity undertaken during the course of the camp.
- I give permission for COR KIDS group to take photos of my child/myself and store photos of my child/myself. Additionally, I authorize photos of my child/myself to be posted on social media.
Parents' signature:*
Should be Empty: