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GYM Camp Junior
TO BE COMPLETED AND SIGNED BY PARENT/ GUARDIAN/ CAMPERS (18+)
Personal Information
Camper's Full Name
*
Date of Birth
*
Home Address
*
Church Name
*
Health Information
Please select and explain if the camper:
Suffers from any medical condition
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(heart condition, asthma, blackouts, etc.)
Yes
No
Is taking any medication
*
Yes
No
Is allergic to any foods, or drugs, or has any special care needs
*
Yes
No
If there are any other factors that we need to be made aware of
*
Yes
No
Payment Information
You will not be able to submit this form without attaching proof of payment.
Banking Details
BANK:
ABSA
Account Holder:
PAUL SCHLEHLEIN
Account Type:
SAVINGS
Branch:
MAKHADO/ LOUIS TRICHARDT
Branch Code:
8561
Account Number:
9173950674
Reference:
GYM+NAME+SURNAME
Price:
R695 (ages 8-15)
*No Refunds.
Please Upload Proof of Payment
Click to choose a file or drag here
Size limit: 10 MB
*
By checking these boxes I understand that:
*
I consent to my child's attendance and participation at GYM Camp and all related activities in Limpopo, South Africa, including any transportation involved in connection with the camp.
I accept that participation in the camp and its activities is undertaken at my/ my child’s own risk. I hereby indemnify and hold harmless GYM Camp, its staff, camp leaders, assistants, volunteers, and any other persons involved in the camp from any claim arising from injury, illness, and/ or loss of or damage to personal property sustained during or arising from the camp.
I further authorise the camp leaders and their assistants to act in loco parentis (in the place of a parent) during the camp. In the event of an accident or illness which, in the opinion of the camp leaders, requires medical attention or evaluation, I authorise them to obtain such medical attention and understand that I WILL BE RESPONSIBLE FOR ALL MEDICAL AND ASSOCIATED COSTS.
I consent to appropriate photographs and/or videos of myself/ my child taken during the camp being used by GYM Camp for reporting, communication, and promotional purposes.
Any individual dietary requirements or restrictions of myself/ my child are my responsibility, and I will make the necessary arrangements to accommodate them.
Parent's/ Legal Guardian's Signature
*
Signature
Submit
