Registration Form

Please note: The submission of a registration form does not automatically guarantee a place at Camp.
We receive more registrations than actual spaces available. Successful registrations will be contacted via
email or phone and sent a Follow Up form. 

If you would like to come to Camp Out, but are not able to ask for your parents' permission for any reason, please contact us on 0413 339 936.


Information provided in this form is strictly for the use of Camp Out crew and will remain completely confidential. Camp Out Crew are mandatory reporters: this means that if you give us information in this form or at Camp that suggests you are currently experiencing abuse of some kind or are at significant risk of experiencing abuse, we are obliged to report that information.

Campers Details
For campers to complete
Legal Name *
Legal Name
Date of Birth *
Date of Birth
During Camp Out, Campers are encouraged to explore and use names of the Camper’s choosing. You can have multiple names, or one name or a name that you only use at certain times. Just remember that you can change your name, use your name and stop using your name whenever you want!
A chosen gender pronoun is a set of words that people should use when they refer to you. An example of gendered pronouns are he, she, him and her, and examples of nongendered pronouns are they, you and I. At Camp Out, you get to decide what gender pronouns you prefer, or you can choose to be gender neutral! Your gender identity is for you to decide!
We encourage campers to let us know if they identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, pansexual, genderqueer, genderfluid, sex and/or gender diverse or any other kind of wonderful queer identity-- however, Camp is also exactly the place to learn about these kinds of identities and what they mean and how they fit together, and we definitely don’t expect anyone to have everything worked out! Don’t stress if you would prefer to leave this part blank for now or if you’re still thinking about what words feel comfortable for you and why.
Have you ever been to Camp Out before? *
SPECIFICS...
Check with a parent/guardian
How confident are you in your ability to swim?
eg. Insomnia, sleep walking, snoring, light sleeper
Have you previously attended an overnight camp? *
Do you experience homesickness?
Parent/s or guardians details
For parent/s or guardians to complete
Name *
Name
Emergency Contact
Name *
Name
Referral
*
Is the booking for the child being referred to Camp Out by community services or a similar agency?
If Yes, have you read the agency’s guidelines on the placement of children into holiday programs?
Travel
This year, campers will be picked up in hired buses from Broadmeadow train station. Crew will be present at Central train station, Gosford train station, and Broadmeadow train station to accompany campers to the bus pick-up.
Medical Details
To help the Crew take the best care of you, let us know, down below, if you have any medical conditions that we should be aware of? Do you have any of the following conditions?
If yes, please describe in detail
If yes, please describe in detail
If yes, please describe in detail
Mental Health
If yes, please describe in detail
If yes, please describe in detail
If yes, please describe in detail
Doctor's/Healthcare professional Details
Name of Family Doctor *
Name of Family Doctor
including position on card
Medications
If the young person will be taking medication while at Camp Out 2016, please let us know every detail to ensure their health and safety. If you need more space, please use the notes section at the end of the form. All medication will be stored in a secure lock-up and administered by a first-aid trained crew member.
Will they need reminders to take their medication?
Will they need reminders to take their medication?
A NOTE TO PARENTS *
Although every care will be taken to ensure the young person’s safety and wellbeing, parents/guardians are asked to encourage them to behave in a responsible manner at all times. In the event of an accident or illness requiring medical treatment, every effort will be made to contact the parents/guardians before such treatment is sought. However, should this prove impossible, it will be necessary for authority to be given for the treatment to be undertaken. In order to adhere to Camp Out policy on administering of medicine, parent/s or guardians must provide a signed letter of instruction if the young person requires medication during their time at Camp Out.
Permissions
Permission for images of art work *
I hereby give permission for photographs of my young person’s artwork to be used for future Camp Out events attended by past and future Campers and Crew.
I hereby give permission for photographs of my young person’s artworks to be used for the publicity and promotion of Camp Out, including online. *
Permission for images of young person *
I hereby give permission for photographs of my young person to be used for future Camp Out events attended by past and future Campers and Crew.
I hereby give permission for photographs of my young person to be used for publicity and promotion of Camp Out, including online. *
Notes

REGISTRATION

Registration is necessary prior to the commencement of the Camp to secure your place. Late registrations will be accepted at the discretion of the Camp Crew. Sending a registration does not automatically guarantee a place at Camp.

PAYMENT

Camp Out has a Sliding Scale system, so you pay what you can afford. Our price guide suggests anywhere between $0-$200. No one will be turned away for lack of funds. Further payment information will be provided closer to the date.

PRIVACY DISCLAIMER

The personal information provided by you on this form, will be used by staff at Camp Out, to provide your child with a safe and high quality Camp experience. The information will be accessible to relevant Camp Out staff. The information may be disclosed to the Department of Community services, a court of law or other government agency if we are required by law to do so; or with a health agency if there is a serious and imminent threat to a person’s life, health or safety. Otherwise, this information will only be disclosed with your prior written consent, with the intended recipient of the information and the reason for sharing the information being clearly stated.

REFUNDS AND CANCELLATIONS

Requests for refunds must be made at least seven (7) working days prior to the commencement of the Camp. All requests must be made in writing. Refunds will not be given for partial attendance. Camp Out Inc reserves the right to cancel or alter any camp activities. 

In case of significant changes to the camp program, every effort will be made to give reasonable notice to those who have registered, and those registered will be offered a full refund should they no longer attend camp. Camp Out will collect and store the information you provide to enable processing of registrations for the camp. 

The information will be provided to workshop facilitators and Camp Crew, where necessary, and you consent to this disclosure. Any information provided by you will be stored on a database that will only be accessed by authorised personnel and is subject to privacy restrictions. The information will only be used for the purpose for which it was collected.

The information will be held by Camp Out Inc for a period of time after camp in order to meet our legal requirements, after which it shall be destroyed. Any information provided by you to Camp Out Inc can be accessed by you during standard office hours with reasonable notice from you. You can can be change and update this information by writing to us.