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Activities Consent & Medical Form

Easter Camp 2023



Today's Date: April 19, 2024

Please complete ONE form for EACH person participating in any Camp Activity

AUTHORISATION & CONSENT

  1. I Agree/We give permission for the participant to participate in SNSW Easter Camp activities, these include offsite activities of: Waterskiing/Swimming at Lake Jindabyne. As well as onsite activities of; Mountain Biking, Frisbee Golf, Bike riding on the Pump and Flow Tracks and other onsite games. Activities are operated and supervised according to each department's timetable (see leader for more information) and not withstanding all care give in supervision. Activities undertaken outside of these supervised times are done so at your own risk. I/we accept that there are risks in activities and agree to participate in a manner that does not jeopardise the safety of others or the integrity of SNSW Easter Camp and agree to participate at my /his / her own risk.
  2. In the event of accident or illness: I agree where it is impractical to communicate with me that if I/my son/daughter suffer injury or illness, the organisers can arrange medical treatment and emergency evacuation services as the organisers deem necessary for my/my son/daughter's safety or wellbeing. I/we agree to pay the appropriate fees for such and any ambulance or other emergency transportation costs, which may be required.
  3. I am aware, in signing this document, of the risks and demanding nature of activities at Easter Camp 2023 and I am willing to accept this risk and agree to release, to the full extent permitted by law, Australasian Conference Association Limited (ACN000 003 930) and its employees and agents from responsibility for any injuries which may occur as a result of participation in Easter Camp 2023 and its activities.



Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Department*

List campsite number if known

OR

I am staying off site
Yes

Please select the appropriate answer.  If you answer 'Yes', please supply full details on the lines below:

Heart problems*
No
Yes
Respiratory problems*
No
Yes
Asthmatic*
No
Yes
Diabetic*
No
Yes
Recent illness*
No
Yes
Migraines*
No
Yes
Blackouts*
No
Yes
Sleepwalking*
No
Yes
Medication*
No
Yes
Special diet*
No
Yes
Recent Operations*
No
Yes
Fits, epilepsy, etc*
No
Yes
Disability*
No
Yes
Reaction to drugs*
No
Yes
Allergies*
No
Yes

Last Tetanus Booster date: *

Details:

Allergies:

EMERGENCY CONTACT INFORMATION

Please supply contact details of a parent /guardian/relative who is ATTENDING CAMP and is to be notified in case of an emergency.


Emergency Contact Name: *

Mobile Number: *

Relationship: *
During this camp, we SDA Church (SNSW Conference) anticipate that photos and videos may be taken of those who participate in the activities. These images and videos may be used on the SNSW Conference & Adventist Alpine Village websites as well as the Imprint Magazine. Do you give consent to this?*
No
Yes
First Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Department*

List campsite number if known

OR

I am staying off site
Yes

Please select the appropriate answer.  If you answer 'Yes', please supply full details on the lines below:

Heart problems*
No
Yes
Respiratory problems*
No
Yes
Asthmatic*
No
Yes
Diabetic*
No
Yes
Recent illness*
No
Yes
Migraines*
No
Yes
Blackouts*
No
Yes
Sleepwalking*
No
Yes
Medication*
No
Yes
Special diet*
No
Yes
Recent Operations*
No
Yes
Fits, epilepsy, etc*
No
Yes
Disability*
No
Yes
Reaction to drugs*
No
Yes
Allergies*
No
Yes

Last Tetanus Booster date: *

Details:

Allergies:

EMERGENCY CONTACT INFORMATION

Please supply contact details of a parent /guardian/relative who is ATTENDING CAMP and is to be notified in case of an emergency.


Emergency Contact Name: *

Mobile Number: *

Relationship: *
During this camp, we SDA Church (SNSW Conference) anticipate that photos and videos may be taken of those who participate in the activities. These images and videos may be used on the SNSW Conference & Adventist Alpine Village websites as well as the Imprint Magazine. Do you give consent to this?*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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