Camp Registration Form Camp you'd like to register forWPKC April Space Camp 16-20Type of Registration(Required)Campers Registration - First timeCampers Registration - ReturningCamp Leader, LIT or Adult Helper - First timeCamp Leader, LIT or Adult Helper - ReturningCampers Cost: $220. Leaders Cost: Uni / Tertiary: Koha, Y13: $70, Y12: $80, Y11: $90, Y10: $100, Y9: $110I would like to participate as a(Required) Camper 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 School Year(Required)Year 9Year 10Year 11Year 12Year 13Univ / TertiaryParent / Guardian DetailsParent / Guardian Name(Required) 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(Required) Relationship to camper(Required) Mobile(Required)Work PhoneHome 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 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 Agree to sign electronically(Required) Yes No Is there anyone who is not allowed legal access?(Required) No Yes Enter name of person / people not allowed access(Required) I would like to be in a cabin with How did you find out about us? Payment Method(Required) By Bank Transfer By Cash at the Camp I declare the information I have submitted is true and correct(Required) Yes No Any other comments of questionsSection BreakCommentsThis field is for validation purposes and should be left unchanged.
