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					                       APPLICATION FORM
CAMPERS DETAILS                                                                        For more info contact Ministry Camp Coordinator:

                                                                                                        BRIANNA O’KEEFFE
CAMPERS NAME: ….…………………….....................…….....
                                                                                           Warrambui Retreat and Conference Centre
Male/Female                      DOB: ......................................
                                                                                                           02 6220 1000
                st
AGE (as at 1 Jan. 2010): .............................................                              programs@warrambui.org

EMAIL ADDRESS: ..........................................………........               ** Please note the office will be closed for Christmas break 23rd
                                                                                                   December—10th January 2010
2nd CAMPERS NAME: .........……………............................                                                                                                    Real Jesus
Male/Female                      DOB: ......................................

AGE (as at 1st Jan. 2010): ..............................................              Post or fax your forms and payment before
                                                                                                                                                               Real Grace
EMAIL ADDRESS: ..........................................................
                                                                                            Friday 21st of December 2009 to:

ADDRESS: …………..…………………..………………...................                                                       WARRAMBUI
                                                                                                                                                                               &
                                                                                                      Attn: New Heights                                                   reat
………………………….................. POSTCODE: ………...….......                                                                                                          bu  i Re t     re
                                                                                                      322 Greenwood Rd                                 War
                                                                                                                                                           ram          Ce nt
                                                                                                                                                                   nce
PHONE: (......)...…………………….......................................                                                                                            fe re
                                                                                                 Murrumbateman NSW 2582                                 Con
                                                                                                                                                                                   15th-17th Jan 2010
PREFERRED METHOD OF CONTACT: EMAIL/LETTER                                                                                                                                               16-20yrs

PARENTS/GUARDIAN
Name of Emergency Contact: ......................................
                                                                               Warrambui needs to upgrade the Dome building, to keep up
Relationship (eg—parent): ...........................................
                                                                               with ChildSafe standards by adding extra beds with en-suited
Contact Phone Number: ..............................................           rooms for teachers and leaders. To do this, the NSW/LCA is
                                                                               undertaking an appeal to raise $180,000. We’ve already
                                                                               raised over $115,000, and you can help!


                                                                               •        Pray
     HAVE YOU INCLUDED EVERYTHING FOR
               REGISTRATION?                                                   •        Donate
           •         Application Form                    Y/N                   •        Keep Up to Date
           •         Medical form                        Y/N                              www.lcansw.org,au/warrambui

           •         Payment                             Y/N
                                                                                                                                            TRAVEL ARRANGEMENTS
                                                                                                                          What are your travel arrangements to come to camp:
                                                                                                                         Private car:                                          Yes/No
                                                                                                                         Catch a public train/bus to Yass:                     Yes/No
What is New Heights?                                                                                                      Arrival Time: ..........................................................
New Height’s is a youth camp aimed at older teens and young adults who wish to take their relationship with                Departure Time: ....................................................
Christ to ’new heights’. We will be rediscovering who Jesus really is, how he lived his life and what it means to         Location of arrival: .................................................
live under grace.                                                                                                                                  CAMP PAYMENT
                                                                                                                         Payment Options:
When & Where?
                                                                                                                               •        Cheque payable to Warrambui
Camp starts at 6:00pm for dinner, Friday 15th January, finishing at 2:00pm Sunday 17th January 2010, at
Warrambui Retreat and Conference Centre, off the Barton Highway near Murrumbateman.                                            •        Money order payable to Warrambui

                                                                                                                               •        Direct Debit*
Who is it for?
                                                                                                                               •        Credit Card*
‘New Heights’ is for youth 16 – 20 yrs of age.
                                                                                                                                                             Cost            Qty        Total
How do I apply?                                                                                                                                                                         Amount
                                                                                                                         1st Camper Member                   $100.00
Just fill in the registration form and medical form and send it to us with your camp payment before December
21st 2009.                                                                                                               2nd Camper Member                   $85.00

Is there a bus?                                                                                                                    DOME IMPROVEMENT DONATION

No, there won’t be a bus available for this camp, however pickups from Yass Town (bus) or Yass Junction (train)                        (See over page for more info):
                                                                                                                                         TOTAL AMOUNT INCLOSED:
will be available if your preferred option is to travel by public transport. It is important that you let us know your
travel arrangements.
                                                                                                                         *For credit card and direct debit options, please visit the
                                                                                                                         district website: http://www.lcansw.org.au and advise us
Costs:                                                                                                                   when done so.

1st Child:                       $100.00                                                                                 I, the undersigned, hereby declare that Warrambui, Turn-
2nd Child:                       $85.00                                                                                  ing Point Ministries and the Lutheran Church of Australia,
                                                                                                                         its officers and servants are free from all responsibility
Camp Forms                                                                                                               whatsoever for any accidents or illness resulting from my
                                                                                                                         own/child’s participation in this camp. I give permission
If you need more camp forms, you can download them from the website! www.lcansw.org.au/camping
                                                                                                                         for any medical treatment that may become necessary for
                                                                                                                         me/my child.

                                                                                                                         Signature: .............................................Date: ..............

                                                                                                                         (Signature of Parent/Guardian if under 18yrs of age)

				
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