BUSSELTON
One Youth Camp
2025

I understand that Payment needs to be made in order to attend this camp, I plan on making the payment as soon as I can

Check

I need information about financial assistance for this camp

Check

Camper has been sponsored financially for this camp

Check

I have already paid for this camp

Check

I understand that my camp registration is NOT confirmed until I have signed my eForm containing consent *

Yes

No

Campers Name *

First Name

Last Name

Gender *

Male

Female

Parent/Guardian information *

First Name

Last Name

Phone/contact number *

(###)

###

####

Parent/Guardian information #2 *

First Name

Last Name

Phone/contact number #2 *

(###)

###

####

Emergency Contact #1 Name *

First Name

Last Name

Phone Number *

(###)

###

####

Emergency Contact #2 Name

First Name

Last Name

Phone Number

(###)

###

####

Is this participant covered under Medicare *

Yes

No

Does the participant have ambulance cover *

Yes

No

Do you give permission for the First Aider to administer the following non-prescription medications if needed? *

Panadol

Antihistamines

Ibuprofen

None of these

Any/All of these

Will this participant need to take medication on camp? *

Yes

No

Is there any additional information you could provide to help our volunteers care for your child? (Family, behavioural, mental health, medical condition that require special attention?)

Yes

No

Please rate the participants swimming ability *

Cannot swim

Fair

Good

Excellent

Sunscreen Application Consent

You are being asked to authorize One Youth Camp personnel (Camp Directors) to provide your child with a commercial brand sunscreen lotion for his/her application if your child forgets to bring his/her sunscreen for them to participate in planned outdoor activities. If you permit your child to use sunscreen provided by the camp, you also agree to release, indemnify, and hold harmless One Church Perth and any of their staff and volunteers from lawsuits, claims, expenses, demands or actions against them for the application of sunscreen lotion for your child. I GIVE permission for the camp director to provide my child with a commercial brand sunscreen lotion

Yes

No

Do you consent to appropriate use by One Church Perth of photographs/video taken on the program that includes this participant? *

Yes

No

I have read, understood and agree with the above *

yes

No