Foursquare Youth Camp
12th-15th April ‘10
What: On Mon April 12th a bunch on young people from all
over the state will be coming together in Busselton for a huge
WA Foursquare Youth camp. A great chance to encounter God,
catch up with old friends & make new ones. It’s set to be
awesome so don’t miss out!
When: Monday 12th- Thurs 15th April 2010. See your youth
leader for departure and arrival home times.
Where: Foursquare campsite, Caves road Busselton
Cost: $80- includes accommodation, meals & activities.
What to bring: Sleeping bag/ Pillow
Money for canteen (optional)
Bible & notebook
REGISTRATIONS CLOSE 1st April
Completed permission/ medical form (attached) required to
For more info or bookings contact your youth leader.
Foursquare Youth Camp
Medical Release & Travel Consent Form
Date of birth_______________________
Parent/ Guardian name__________________________________
Is your child currently taking any prescription/ non prescription
medication? YES / NO
Date of last tetanus shot______________________
Any other information leaders should know about with regards to your
child participating in Foursquare Youth activities?
My child is a competent swimmer. Stage_________
My child is not a competent swimmer & requires extra attention in the water.
I am the Parent/ Guardian of _______________________________ and I
hereby give permission for him/her to attend the Foursquare Youth Camp
held in Busselton on 12th-15th April 2010. I give my consent for him/her
to travel in the vehicles/transportation provided by the staff, both to and
from camp and throughout the duration of camp when required.
I acknowledge that while the camp staff will take all reasonable care for the safety
and wellbeing of my child/ren while under their supervision, no liability will be
In the event of my child/ren requiring medical attention I understand that the
camp director will endeavour to communicate with me concerning the required
action. If this is not possible, the person in charge will administer or oversee
whatever treatment he/ she judges to be reasonably necessary.
I hereby give permission for the leaders of the activity to contact any emergency
services where appropriate, or required in an emergency situation. In the event of
a medical emergency I also consent to my child/ren receiving any medical,
surgical or anaesthetic care which may be determined by the appropriate medical
practitioner or hospital authority to which my child/ren has been taken for such
care. In such a situation, I also accept responsibility for the cost of any medical
I hereby give permission for Foursquare Youth WA to take & collect any
photographic images (including video footage) of my child/ren to be used by
Foursquare Youth WA in any printed publication, newsletter, Foursquare Youth
WA internet website or in any other electronic formats for press, media releases
or other suitable purposes.
I give consent for media release
I do not give consent for media release
Upon signing this form I acknowledge that I have read, understood
and agreed to the terms & conditions above.
Parent /Guardian name _________________________________
Parent/Guardian signature ________________________________