Participant Form :: Gold Coast 2012 Camp “Passion For Serving Christ”
(To be filled in by each participant and handed to his/her youth leader with payment by 01th Dec 2011)
Personal & Travel Information
Name: Surname: Telephone(s):
Email: Age (if under 16, you must attach a Gender:
completed & signed Parent Consent Form):
Arrival Date and Time: Arrival Flight No and Airline: Arrival From:
Departure Date and Time: Departure Flight No and Airline Destination:
Allergies or Medical Conditions: ____________________________________________________________________________________________________
Special Diets: ___________________________________________________________________________________________________________________
Emergency Contact (Name & Phone No): ____________________________________________________________________________________________
Church Information
Church Name: Church Pastor:
Church Youth Leader: Youth Leader for Camp:
Camp Rules:
1. Transport to and from camp will be by the chartered buses only.
2. Participants come under coordination group and youth leader’s authority.
3. Participants’ age will be 16 and over. Exceptions made for those participants that have both parental consent (signed) and youth leader’s approval.
4. Recreational activities DO Not include swimming pool use.
5. The youth will take part in all activities on time.
6. Decent attire and courteous language to be observed at all times.
7. A disciplinary commission will be set up for supervision.
8. Boys are not allowed in girls’ rooms, nor girls in boys’ rooms / tents.
9. All mobile phones to be switched OFF during all services.
10. Lights Out will be at the program times or as announced by camp leaders.
11. Notwithstanding with these rules, sanctions will apply.
I have read and agree with all camp rules.
Signature: _________________________________ Date: ________________________
Payment:
Amount $ __________ Date: _________
PARENT/GUARDIAN CONSENT FORM
To be used by participants between 14 to 16 years of age
EXCURSION DETAILS:
Excursion to:…………………………………………………………………………..…………...
Purpose of excursion…………………………………………………………………….............
Departure: Date:………… Time:………………Place:………………………………………….
Return by: Date:………… Time:………………Place:………………………………………….
Delegated Supervisor(s)…………………………………………………………………………..
Mobile Phone Number of Supervisor(s)…………………………………………………………
Method of transport: Public Private (Describe)………………………………………….
Number of students:…………….Student/supervisor ratio:……………………………..(max)
Cost of excursion: $............................per child (To accompany this form)
STUDENT DETAILS:
Student’s Name:…………………………………………………………Age:…………………...
Disabilities (if any):…………………………………………………..………..…………………...
Allergies (if any):…………………………………………………..………..……………………...
Food requirements or food disallowed (if any)…………………………………………….……
STUDENT MEDICAL DETAILS:
Please detail any current medical conditions and treatment plans for your child, relevant to this
excursion.
………………………………………………………………………………………..………………
………………………………………………………………………………………..………………
………………………………………………………………………………………..………………
………………………………………………………………………………………..………………
………………………………………………………………………………………..………………
EMERGENCY CONTACT:
Name: ………………………………………………….Phone: …………………………………
Relationship:………………………………Medicare No:……………………………………….
PARENTAL CONSENT:
As Parent/ Guardian of ……………………………………………………………………………………………..
I hereby give my consent for him/her to participate in the above excursion event and agree to delegate my authority
to the delegated Supervisor(s) listed above. I understand that the Supervisor(s) have recognised that they have a
duty of care for my child and have agreed to undertake full care and responsibility for the safety, well-being and
organisation of my child and to follow my instructions regarding any disability, allergy, food requirements or food
disallowed and/or any other medical concerns described above and, if they do that, and if they provide proper care, I
hereby agree to indemnify them against any future liability for any accident or incident involving my child during the
excursion whatsoever.
Parent/Guardian Signature: ……………………………………………………..
Date: ……………./……………../20…….
Youth Leader Signature: ……………………………………………………..
Date: ……………./……………../20…….
Youth Leader Form :: Participants’ List to Gold Coast 2012 Camp “Passion For Serving Christ”
To be completed by 01th Dec 2011 and emailed to farcau_ovydyu@yahoo.com
Church: ________________________________ Senior Youth Leader*1: ____________________ Mob.
_________________
Name Surname Age Gender Payment Rm^2 Mobile Phone
Leader
1
Participant
2
Participant
3
Participant
4
Participant
5
Participant
6
Participant
7
Participant
8
Participant
9
Participant
10
Name Surname Age Gender Payment Rm^2 Mobile Phone
Leader
2
Participant
12
Participant
13
Participant
14
Participant
15
Participant
16
Participant
17
Participant
18
Participant
19
Participant
20
Name Surname Age Gender Payment Rm^2 Mobile Phone
Leader
3
Participant
22
Participant
23
Participant
24
Participant
25
Participant
26
Participant
27
Participant
28
Participant
29
Participant
30
Name Surname Age Gender Payment Rm^2 Mobile Phone
Leader
4
Participant
32
Participant
33
Participant
34
Participant
35
Participant
36
Participant
37
Participant
38
Participant
39
Participant
40
Name Surname Age Gender Payment Rm^2 Mobile Phone
Leader
5
Participant
42
Participant
43
Participant
44
Participant
45
Participant
46
Participant
47
Participant
48
Participant
49
Participant
50
Name Surname Age Gender Payment Rm^2 Mobile Phone
Leader
6
Participant
52
Participant
53
Participant
54
Participant
55
Participant
56
Participant
57
Participant
58
Participant
59
Participant
60
*1please include yourself (senior youth leader) in one of the tables as well, and also your wife if she will be joining
you.
^2do not fill in the “Rm” (Room) column. This column will be used later to when rooms are allocated.