Urban Camp - Member Application Form

If you are a Challenge member and patient who would like to attend Urban Camp, please fill in the form below:
  • Applicant/Camper Information

  • If there is any chance your child has come into contact with a contagious disease (such as Colds, Flu or Chicken Pox) before attending camp, it is in the interest of other Challenge members that you notify the office as soon as possible on 9329 8474.

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  • Medical Information

  • A Nurse will be on full-time duty during the trip. All information is confidential and solely for the guidance of the Nurse. If a sibling or friend is attending, please detail if any medical information is needed.

  • Patient-Specific Information

  • NOTE – If your child is currently on treatment or has been on treatment in the last 6 weeks, we will need a doctor approval form to be signed by your oncologist. This form will be sent out to you if your child’s application has been successful for final confirmation.
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  • DD slash MM slash YYYY
  • Medication details

  • If your child requires medication, please bring any medication required upon drop off. Please ensure all medicines are clearly labelled in a zip lock plastic bag. The nurse will receive, store and administer the drugs as directed.
  • Parent/Guardian details

  • Consent Form

  • Your signature below indicates approval of the following:

    I permit my child to attend Challenge’s trip and participate in the activities provided as part of 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 or myself;

    3. Challenge has permission to use my child’s image or likeness or voice in print or on tape or film in Challenge Newsletters, social media or other publications;

    4. I, for myself and my child, 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 or my child resulting from injury sustained at Camp).