Camper Registration Form

Camp Registration Form

Wednesday 1st October - Friday 3rd October, 2025

We welcome our school aged community and their school aged sibling/s to join in the excitement at Camp at our new venue Bickley Outdoor Recreation Camp!

Camp offers a wonderful opportunity for respite, self development, mateship and non stop fun. We can offer 3 different ways for your child (the camper) to get involved:

1. Full Camp: staying at Bickley Outdoor Recreation Camp for 2 nights from Wednesday 1st to Friday 3rd October

2. Day Camp: coming along for a full day of activities, joining in with our Full Campers from 11am to 5pm on Wednesday 1st and 9am to 5pm on Thursday 2nd October

3. Transition Camp: ideal for first timers to understand what Camp is all about, we welcome our transition campers to join us for an action-packed part day.

After filling out all the details in the following form, it will be automatically sent to our Camp Coordinator, Kymberley, who will be in touch. If you need some more information or have any questions as you go through this form, please reach out to Kymberley on kymberley@neuromuscularwa.org.au or phone 0432 355 884.

What day/s will the camper be attending Camp?*

Full Camp - 2 night stay from Wednesday 1st to Friday 3rd OctoberDay Camp - 9am to 5pm on Wednesday 1st and Thursday 2nd OctoberTransition Camp - partial day attendance (on either Wednesday or Thursday)

Name*

First NameLast Name

Date of birth*

Does the camper have a neuromuscular condition?*

YesNo, the camper is a sibling of someone with an NMC

Type of neuromuscular condition*

Address*

Street Address

Street Address Line 2

Suburb

Postal Code

Parent Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email Address*

example@example.com

Emergency Contact Name (different to parent details above)*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Does the camper have any of the following health conditions? (please select as many as apply)

*We require a care plan to be provided if any of the following conditions are present;

diabetes, anaphylaxis, asthma, depression, or epilepsy.

Please note, that further information or a care plan may be requested by coordinator about other health and medical information selected.

If your camper has an allergy or incontinence, please provide some further information*

Please upload the care plan/s below for all relevant health conditions your camper has *

We require a care plan to be provided if any of the following conditions are present: diabetes, anaphylaxis, depression, asthma or epilepsy.

Does the camper present or is diagnosed with any of the following?

Any mental health conditions or concernsAutism Spectrum DisorderBehaviours of concern (such as angry outbursts, aggression, a tendency to run away, refusing to follow rules)Bipolar DisorderConduct DisorderOppositional Defiant DisorderOther, please type here

Please elaborate on how this impacts your child's behaviour in a group or school setting?*

Please upload any helpful documentation regarding your child's behaviour. If your child has a behaviour support plan, please upload this here.

Is there anything to consider for the camper that may impact their enjoyment during Camp?

Does the camper have any communication requirements?*

YesNo

Please list any communication requirements the camper has below.

Is the camper taking any prescribed medications that will need to be administered during their time at Camp?*

YesNo

Is the camper currently taking any non-prescribed medications they need while at Camp?*

YesNo

Is the camper currently taking any nutritional supplements they need while at Camp?*

YesNo

Please share details for all prescribed & non-prescribed medications & nutritional supplements that will be needed at Camp below. All medications must be provided in a blister pack supplied by your pharmacist.

Rows	Medication Name	Medication Type	Time to be Taken	Dosage	Administered	Storage	Known Side Effect	Response to Side Effect	Reason for Use
1
2
3
4
5
6
7
8
9
10

Please share any further details on medications below. Make sure you elaborate on any medications you selected 'other' for the administration or storage in the table above.

I give permission for the Camp Coordinator/Nurse to assist in the administration of the following medication as required:

ParacetamolIbuprofenBites and stings cream

We employ trained support workers to assist with campers' personal care needs for the duration of camp. To ensure the support workers have all skills & competencies to provide safe care for your camper, please carefully & accurately share your camper's most up-to-date support needs & equipment use.

Will the camper be bringing their own support worker to camp, even if only for part of the time?*

YesNo

Please upload a scan or photo of your support worker's Working With Children Check. If you do not currently have access to this, once arranged please email it to Kymberley

Please let us know what times the camper's support worker will be attending camp below.

Carefully indicate the camper's current level of mobility using the drop down function & share with us the equipment that is used to assist, where applicable.

Walking*

Equipment used for walking and any further details:

Transferring*

Equipment used for transferring and any further details:

Turning in bed*

Equipment used for turning in bed and any further details:

Toileting & showering*

Equipment used for toileting & showering and any further details:

If the camper has a transfer plan, please upload here. Please note this is not essential.

Please note, the support workers employed are not permitted to lift to assist with transfering for the safety of both campers and support staff. Appropriate equipment must be used at all times at Camp.

At Camp, Neuromuscular WA will ONLY provide the following equipment:

Fully adjustable electric beds & pressure care mattress (only provided on request)
Standard/adult sized shower commode
Hoist with loop sling attachments

The camper will need to bring with them to Camp all of the following items, if they use them:

Sling
Any other personal care items

If you cannot source your own personal care item that you need to bring for use at Camp, or would like to have a further discussion about equipment, please reach out to Kymberley.

Does the camper require an electric bed?*

YesNo

How many single power points does the camper require for equipment at night?*

Please provide as much detail as possible about any special requirements during the night or sleeping habits that you would like care staff to be aware of:

Diet*

Please upload your enteral (PEG) feeding mealtime management care plan*

Food likes:

Food dislikes:

Food allergies and/or intolerances:*

Although we hope it will never be required, a hospital emergency plan will provide relevant information to the coordinator, paramedics and support staff so it is known exactly how to coordinate the care of your child, should an emergency occur.

Where will the camper's parents/guardians be located during the camp?*

Please advise of any specific instructions that you would like the Camp Coordinator to communicate to paramedics in the event of emergency?

PLEASE NOTE: in the event of a Neuromuscular WA-determined emergency, an ambulance will be called regardless of a family's health insurance or ambulance cover, or our ability to reach an emergency contact.

Movies

Movie night is a staple at Camp, giving an opportunity to watch a carefully-selected movie under staff supervision. To make sure it is audience-appropriate, we ask for permission from parents to watch movies of different ratings.

I give permission for the camper to watch movies of the following ratings (select all that apply)

G RatedPG RatedM Rated

Please list some of the camper's interests

Camp Activities

Camp staff will go to all lengths to ensure camp-based activities are carried out safely. However, all activities carry an element of risk.

I give permission for the camper to participate in supervised activities at Bickley Outdoor Recreation Camp as part of the Neuromuscular WA Camp, if scheduled in the camp itinerary.*

YesNo

Camp Merch

To reduce our impact on the environment and Camp costs, we ask that if you have a Camp shirt from last year that still fits, please bring this rather than ordering a new shirt (these are identical to last years).

If you need to order a new shirt, have a look at the size guides below.

If you would like to order a new Camp t-shirt (please note these are identical to last years), let us know what size t-shirt your camper wears

Have you had funding for Camp included in your current NDIS plan?*

YesNo

You are still eligble to attend Camp in 2025.

Kymberley will be in contact to provide a quote to include in your next plan review.

DECLARATION*

By ticking this box and submitting this form, I declare that the answers I have given in this application and the documents I will provide are true and correct to the best of my knowledge and belief. I declare that I have read and understood all information provided and requested in this application.

PERMISSION*

I give permission for myself/my family to be photographed at this or other Neuromuscular WA events. Photographs taken may be used for promotional materials on Neuromuscular WA's website, social media platforms and/or resources developed and may be shared with sponsors who have provided funding towards the program for use on their marketing collateral.No, I do not give permission for photographs

Signature*

Camper Details

Parent/Guardian Details

Camper Health & Medical Information

Care & Support Information

Mobility

Equipment

Nutrition

Hospital Emergency Plan

General

FUNDING

DECLARATIONS / PERMISSIONS