Camp Registration Form Camp you'd like to register forWPKC Road Trip Oct Camp 23Type of Registration(Required)Campers Registration - First timeCampers Registration - ReturningCamp Leader, LIT or Adult Helper - First timeCamp Leader, LIT or Adult Helper - ReturningCamper DetailsName(Required) First Last MobileEmail(Required) Birth Date(Required) DD slash MM slash YYYY Gender(Required)MaleFemaleSchool School Year(Required)Year 5Year 6Year 7Year 8Church / Youth Group Leader School Year(Required)Year 9Year 10Year 11Year 12Year 13Univ/tertiaryParent / Guardian DetailsParent / Guardian Name First Last Address(Required) Street Address City / Town Region Postal Code Home numberMobile number(Required)Parent / Guardian Email Comments, Questions or any information that has changedPlease list any details that have changed since the last camp you attended.Referee - Church PastorWhat Church do you attend and how long have you been there?(Required) Are you involved in church and what specific role do you have?(Required) Youth Pastor's Name(Required) Youth Pastor's Mobile(Required)Youth Pastor's Email(Required) Pastor's Name(Required) Pastor's Mobile(Required)Pastor's Email(Required) Police VettingI consent to Policy Vetting(Required) Yes No Emergency Contact DetailsName First Last Relationship to camper or leader(Required) Mobile(Required)Home PhoneNext of kin name(Required) First Last Next of Kin Mobile(Required)Next of Kin Home PhoneMedical DetailsMedical Conditions / medicationSpecial dietary requirementsLast tetanus shot DD slash MM slash YYYY Paracetamol consent(Required) Yes No Is your child a sleep walker?(Required) Yes No Is your child a bedwetter?(Required) Yes No Is there any other information we need to know?Consent and permissionConsent to be in photos / videos(Required) Yes No Consent for camp activities(Required) Yes No Agree to no camp liability for accident or injury(Required) Yes No Is there anyone who is not allowed legal access? No Yes Enter name of person / people not allowed access Agree to sign electronically(Required) Yes No How did you find out about us? I would like to be in a cabin with Payment Method(Required) By Bank Transfer By Cash at the Camp Other I declare the information I have submitted is true and correct(Required) Yes No Any other comments or questionsCommentsThis field is for validation purposes and should be left unchanged.
