Young Life Camps REGISTER HERE - Young Life Australia

Welcome to Camp registration!

Once you have filled in this form you will be directed to another secure website for online payment. If you require any assistance, please call 1300 557 647 during office hours.

- Step 1 of 5

What you will need to complete registration:
- Emergency Contact Details
- Medical Details
- Medicare Numbers & Family GP Details
- Allergy & Medication Details

Choose your event *

Type of registration *

University *

Please choose your University.

Student ID Number

Please enter your Student ID number.

Level of Study

Student Type

Preferred Payment Method

You will be redirected to a secure payment page at the end of the registration process.

Number of Attendees *

Contact Details

Your Contact Details

Your Name *

First

Last

Your Email *

Your Phone *

Camper1 Date of Birth *

Camper1 Gender *

Camper1 Are you of Aboriginal or Torres Strait Islander decent? *

Camper1 Do you have friends coming that you want to share a room with?

Camper1 What role are you applying for? *

Cabin Leader
Work Crew
Summer Staff (Program, Music, Tech, etc)
Guest / Family

Camper2 Name *

First

Last

Camper2 Date of Birth *

Camper2 Gender *

Camper2 Are you of Aboriginal or Torres Strait Islander decent? *

Camper2 Do you have friends coming that you want to share a room with?

Camper2 What role are you applying for? *

Cabin Leader
Work Crew
Summer Staff (Program, Music, Tech, etc)
Guest / Family

Camper3 Name *

First

Last

Camper3 Date of Birth *

Camper3 Gender *

Camper3 Are you of Aboriginal or Torres Strait Islander decent? *

Camper3 Do you have friends coming that you want to share a room with?

Camper3 What role are you applying for? *

Cabin Leader
Work Crew
Summer Staff (Program, Music, Tech, etc)
Guest / Family

Camper4 Name *

First

Last

Camper4 Date of Birth *

Camper4 Gender *

Camper4 Are you of Aboriginal or Torres Strait Islander decent? *

Camper4 Do you have friends coming that you want to share a room with?

Camper4 What role are you applying for? *

Cabin Leader
Work Crew
Summer Staff (Program, Music, Tech, etc)
Guest / Family

Emergency Contacts, Medical & Allergy Details

Emergency Contact Details

Full Name of Next of Kin (Primary Emergency Contact) *

Primary Phone *

Primary Residential Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Full Name of Secondary Emergency Contact *

Secondary Phone *

Secondary Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Medicare no *

Expiry Date *

Camper 1 number *

Camper 2 number *

Camper 3 number *

Camper 4 number *

Private Health Insurance fund & no

Name & Phone Number of Family GP *

Camper 1

Camper1 Please check the box where appropriate or leave box blank

I object to transfusions
Camper wears glasses/contact lenses
Paracetamol may be given
Ibuprofen may be given
Antihistamines may be given

Camper1 Swimming ability *

Can't
Weak
Fair
Strong

Camper1 Allergies - Medication/Food/Other

Please provide detail or enter none

Camper1 Other conditions or further information we should know about

Camper1 Medication

Please list Medication, Dosage and Self Administer Y/N

Camper1 Special Dietary Requirements *

None
Vegetarian
Vegan
Coeliac/Gluten Free
Lactose Intolerant
Food allergy (please indicate specific allergy below)

Camper1 Other dietary requirements including specific food allergies *

Camper 2

Camper2 Please check the box where appropriate or leave box blank

I object to transfusions
Camper wears glasses/contact lenses
Paracetamol may be given
Ibuprofen may be given
Antihistamines may be given

Camper2 Swimming ability *

Can't
Weak
Fair
Strong

Camper2 Allergies - Medication/Food/Other

Please provide detail

Camper2 Other conditions or further information we should know about

Camper2 Medication

Please list Medication, Dosage and Self Administer Y/N

Camper2 Special Dietary Requirements *

None
Vegetarian
Vegan
Coeliac/Gluten Free
Lactose Intolerant
Food allergy (please indicate specific allergy below)

Camper2 Other dietary requirements including specific food allergies *

Camper 3

Camper3 Please check the box where appropriate or leave box blank

I object to transfusions
Camper wears glasses/contact lenses
Paracetamol may be given
Ibuprofen may be given
Antihistamines may be given

Camper3 Swimming ability *

Can't
Weak
Fair
Strong

Camper3 Allergies - Medication/Food/Other

Please provide detail

Camper3 Other conditions or further information we should know about

Camper3 Medication

Please list Medication, Dosage and Self Administer Y/N

Camper3 Special Dietary Requirements *

None
Vegetarian
Vegan
Coeliac/Gluten Free
Lactose Intolerant
Food allergy (please indicate specific allergy below)

Camper3 Other dietary requirements including specific food allergies *

Camper 4

Camper4 Please check the box where appropriate or leave box blank

I object to transfusions
Camper wears glasses/contact lenses
Paracetamol may be given
Ibuprofen may be given
Antihistamines may be given

Camper4 Swimming ability *

Can't
Weak
Fair
Strong

Camper4 Allergies - Medication/Food/Other

Please provide detail

Camper4 Other conditions or further information we should know about

Camper4 Medication

Please list Medication, Dosage and Self Administer Y/N

Camper4 Special Dietary Requirements *

None
Vegetarian
Vegan
Coeliac/Gluten Free
Lactose Intolerant
Food allergy (please indicate specific food allergy below)

Camper4 Other dietary requirements including specific food allergy

Indemnity and Consent

Please read carefully and provide your consent.

Sun Protection: We strongly recommend you come to the event with a hat, t-shirt (that covers shoulders) & sunscreen. *

Agree

Consent to medical attention: I, the undersigned confirm my consent to the activities I will engage in while on a Young Life activity or camp. I acknowledge the staff and volunteer agents of Young Life will take all possible care but cannot be held responsible for unforeseen accident or illness arising. I hereby consent to medical, hospital, rescue procedures being employed in the best interests of myself and that my emergency contact shall be notified as soon as possible should the continuance of such procedures be necessary *

Agree

Disclaimer: In the unforeseen event of personal injury or illness sustained while on a Young Life activity or camp, or the loss of personal property except where such property was held in the custody of Young Life staff or volunteer agents when lost while on a Young Life activity or camp, I hereby release, and exempt, and indemnify the organisers, sponsors, and all other persons involved in the organisation of the Young Life camp, trip, excursion, from all action, proceedings, demands, costs, expense, and claims whatsoever made or taken by any person arising out of my participation in such camp, trip, or excursion *

Agree

Discipline: If in the event your behaviour is deemed by the organisers to be inappropriate or compromises the safety and/or health of other Attendees on the camp, trip or excursion, then Young Life reserves the right to send you home, at your expense, at the earliest possible time, by the most effective mode of transport, in conjunction with your co-operation *

Agree

Media Consent: Young Life may take photos &/or video footage at Young Life activities and use for promotional purposes. Tick the box below if you agree to photos or footage of yourself being used *

Agree
Disagree

Your Registration is almost complete!

Your privacy: The personal contact/address details you supply on this form will be entered into our database. We may use it to send you further information about Young Life Australia. Young Life Australia adheres to the Privacy Act and will not disclose this information to third parties. If you would like to know what information Young Life holds about you please call 1300 557 647.

I consent to receiving information from Young Life Australia

Terms and Conditions *

I have read and accept the Terms and Conditions

Phone

Welcome to Camp registration!

Contact Details

Your Contact Details

Emergency Contacts, Medical & Allergy Details

Emergency Contact Details

Camper 1

Camper 2

Camper 3

Camper 4

Indemnity and Consent

Your Registration is almost complete!

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