Young Adults Camp 2011

Camp Registration Details

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First Name: (*)
What is your first name?
Last Name: (*)
What is your last name?
Gender: (*)
What is your gender?
Email Address: (*)
We need your email address!
Mobile Number: (*)
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Camp Fees

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Please Select: (*)
Please select a package.
Please Confirm: (*)
Please confirm that you can pay the camp fees this weekend.

Emergency Details

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Emergency contact person: (*)
We need an emergency contact person.
Emergency relationship to camper: (*)
How are you related to this contact?
Emergency contact phone: (*)
What is their contact number?
Medicare number: (*)
This must be accurate!
Medicare ref number: (*)
What is your reference number on your medicare card?
Medicare expiry date:
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Medical Condition

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Any special dietary requirements?:
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Any medical conditions?: (*)
Do you have any medical conditions?
Medical details:
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Any allergies?: (*)
Do you have any allergies?
Allergy details/medications:
Restricted from any activity?: (*)
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Additional details:
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Registration Confirmation

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Please Confirm: (*)
You must read and agree to the warnings and camp rules. For further information contact Rev. Sami.
Click here for the Camp Risk Warnings and Camp Rules.

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Print Registration Form (Paper Version)