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					CAMP REGISTRATION FORM

NAME (CHILD) _____________________________________ Age __________ Boy/ Girl (circle one)

NAME (CHILD) _____________________________________ Age __________ Boy / Girl (circle one)

NAME (CHILD) _____________________________________ Age __________Boy/ Girl (circle one)

NAME (CHILD) ____________________________________ Age __________Boy / Girl (circle one)

SURNAME (CHILD/REN) _________________________________________

PARENT / GUARDIAN
(NAME & SURNAME) ___________________________________________

HOME TEL ____________________________________________________

WORK TEL ____________________________________________________

CELL _________________________________________________________

EMAIL ADDRESS _______________________________________________

POSTAL ADDRESS ______________________________________________

SCHOOL ATTENDING ___________________________________________

DOES YOUR CHILD HAVE ANY DISABILITY OR MEDICAL CONDITION?
YES / NO (CIRCLE ONE) IF YES GIVE DETAILS
_______________________________________________________________

_______________________________________________________________

Please note: If for any reason your child/dren does/ do not complete the camp, no camp fees will be
refunded. Only optional extras which they have not done are refundable. Horse riding is not refundable
and cannot be exchanged for another activity. Lessons not done will be carried over to the next camp

PLEASE READ CAREFULLY THROUGH THE FOLLOWING:

Neither Africa Ablaze nor any person acting for, through or on behalf of Africa Ablaze will be liable for any
loss or damage whatsoever arising from any cause whatsoever. All baggage and personal belongings will
be at the child’s risk at all times. The leaders appointed by Africa Ablaze will at all times be in charge of
the camp and all matters related thereto, and the parents / guardians must abide by their decisions.

In case of emergency where medical treatment is required, I give permission to the camp leaders or Africa
Ablaze staff to obtain the medical services from a medical practitioner or hospital.

I, as parent / guardian of ________________________________________________ declare that I have
read, understood and accept the above-mentioned conditions.

SIGNED _____________________________________ DATE _________________
(Please note: Lost property will be kept for 4 weeks after the camp. Thereafter it will be given to less
fortunate children.)
DATES BOOKED: _______________________________


CAMP ALLOCATION:

Camp Fees: __________________________________________

Paint ball @ R45: ______________________________________

Horse riding lessons @ R70 per lesson: _____________________

Go-Karting @ R40 for 2 laps, R80 for 4 laps: _________________

Archery @ R50 for ½ hour lesson: __________________________

Self-Defence @ R50 for ½ hour lesson: ______________________

Lion Park @ R40: _______________________________________

Table Tennis @ R20 for ½ hours lesson: _____________________

Tuck shop: _____________________________________________

Please fax or email a copy of the deposit slip to 086 5111 636 / mwablaze@mweb.co.za

TOTAL AMOUNT DEPOSITED: __________________________

Date Deposited: _________________________________________

Reference on Deposit: ____________________________________

DEPOSIT ALLOCATION:


Camp Fees: R__________________________________________

Paint ball @ R45: R______________________________________

Horse riding lessons @ R70 per lesson: R_____________________

Go-Karting @ R40 for 2 laps, R80 for 4 laps: R_________________

Archery @ R50 for ½ hour lesson: R__________________________

Self-Defence @ R50 for ½ hour lesson: R______________________

Lion Park @ R40: R_______________________________________

Table Tennis @ R20 for ½ hours lesson: R_____________________

Tuck shop: R_____________________________________________

				
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posted:9/16/2011
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