Surf Camp - Friend Application

Camper Information

Name of Friend*

First Last

Name of the Challenge member friend is attending with:*

First Last

Date of birth*

Gender*

Friend's t-shirt size*

Has the friend ever slept away from home?*

Yes
No

Has the friend ever attended a camp before?*

Yes
No

What is your friend's swimming ability?*

Poor (0 metres)
Fair (less than 50 metres)
Good (50 to 100 metres)
Very good (100 to 200 metres)
Excellent (more than 200 metres)

Has your friend had contact with any contagious diseases within the last six weeks?*

For example: Chicken Pox, Measles, etc.

Yes
No

Please list and describe the contagious diseases:*

Are there any other concerns regarding your friend attending this camp we should know about?*

For example: sleeping habits, etc.

Yes
No

Please list and describe any other concerns:*

Medical Information

A nurse will be on full-time duty during the camp. All information is confidential and solely for the guidance of the nurse/leader.

Does your friend have any physical impairments or limitations?*

For example: hearing, visual, seizures, requiring a wheelchair etc.

Yes
No

Please list and describe any impairments:*

Does your friend have any behavioural or social difficulties?*

For example: ADD, ADHD, ASD, anxiety etc.

Yes
No

Please indicate the behavioural difficulty AND describe how we can support your child if required:*

Does your friend have any allergies or dietary requirements?*

Yes
No

Please list any allergies and dietary requirements:*

Medication details

If your child is successful in this application and requires medication, you will need to bring the necessary medication upon drop-off and ensure that all medications are clearly labelled and placed in a ziplock bag. Our nurse will receive, store, and administer the medications as directed.

Does your friend have any medication requirements?*

Yes
No

Please write the medication instructions for your friend attending, including: drug name, dose, days required, and time(s) of day required.*

Parent/Guardian details

Name

First Last

Relationship to friend:*

For example: Parent, Guardian etc.

Contact email*

Medicare number (in case of emergency)

Private health provider

Private health number

Emergency contact name*

First Last

Emergency contact number*

Family address

Street Address Suburb State Post Code

Consent Form

We regularly use photos/videos to showcase what this camp involves. Do you give Challenge permission to use your child's friend's photos/videos that they appear in for our website, social media, newsletter or other publications?*

Yes
No

If required, do you give consent for your child's friend to be administered Paracetamol and/or any other non-prescription medication (i.e. Panadol, Zyrtec)?*

I confirm I understand and agree to the above.
I do not confirm or agree to the above.

Would you like the camp nurse to call you before administering any non-prescription medication?*

Yes
No

If we are unable to contact you or it is impractical to contact you, do you authorise the nurse/coordinator to consent to your child's friend receiving any medical or surgical attention deemed necessary by a medical practitioner?*

Yes
No

I understand that if my child's friend is successful, I must inform the Challenge staff if my child's friend shows flu-like symptoms, such as a cough or runny nose.*

I confirm I understand and agree to the above.
I do not confirm or agree to the above.

Your signature below indicates approval of the following:

I permit my child’s friend to attend Challenge’s camp and participate in all activities offered during the camp. I acknowledge, agree and warrant that:

1. The information provided by me in this application is true and correct;

2. Challenge accepts no responsibility for the loss, damage or theft of property belonging to my child’s friend or myself;

3. I, for myself and my child’s friend, waive release, discharge and covenant not to sue Challenge, its officers, employees, volunteers or agents from any or all liability from any claims or demands resulting from personal injury, accident or illness (including death of myself, my child, or my child’s friend resulting from injury sustained at camp).

Signature