Day Camp 2022 • Wilberforce Anglican Church

Day Camper Thurs/Fri - please consider providing donation above 0

Child

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

School *

Home Address *

Home City *

Home State *

Home Postcode *

Would like to be in a group with (if possible)

Parent / Guardian Information

Parent 1 First Name *

Parent 1 Last Name *

Parent 1 Contact Number *

Parent 1 Email *

Relationship to Child *

Parent 2 First Name

Parent 2 Last Name

Parent 2 Contact Number

Parent 2 Email

P2 Relationship to Child

Emergency Contacts

These contacts are in addition to the parental contacts already completed.

Emergency Contact 1 Name *

Emergency Contact 1 Relationship *

Emergency Contact 1 Contact Phone *

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Contact Phone

Conditions of Registration

Camp details are subject to change without notice at St. John’s Wilberforce discretion
Consent is given for any or all of the children to take part in any of the Camp’s activities, and I agree to indemnify St John’s Wilberforce Anglican Church, its employees and volunteer workers against any claim arising from any accident involving these children, or any occurrence at the Camp site or during travel to or from the Camp site which, but for this indemnity, may give rise to a claim for damages
Full permission is given to St John’s Wilberforce Anglican Church to use any photographs or videos taken of or including the below children during the Day Camp program for promotion or publicity purposes, including mass media publication, such photographs and/or videos being subject to the exclusive control of the said Anglican Church
In the event of rain or emergency, permission is given for all the above children to be transported by bus to an appropriate venue
Cancellations made up to 14 days prior to the commencement of camp will receive a full refund less an administrative charge of $5. Cancellations made 7 days prior to the camp will incur a cancellation fee of 10% of the camp fee
St John’s Day Camp has a maximum number of campers it can accommodate. If your registration application is received after the maximum number is reached, then a full refund applies
It is understood that your child/children/ward will be actively involved and cooperative in the Day Camp program and they will comply with any reasonable request of the leaders. If this is not the case, parents/guardians may be asked to collect their child/children/ward from the camp site
I agree to the Conditions of Registration (as above) and have read the Day Camp Information Sheet and agree to my child/ward attending Day Camp on this understanding. I have communicated this to my child/ward

Conditions of Registration *

I agree

Date & Time

Day Camper Thurs/Fri - please consider providing donation above 0

Child

Health and Safety Information

Parent / Guardian Information

Emergency Contacts

Conditions of Registration