J Walk Camp 2025 • Springwood Baptist Church

Standard Camper (Purchased after 29th June) 0

I am a: *

Last Name *

First Name *

Date of Birth *

Email Address *

Mobile Number

School Grade *

Parent/Guardian's name *

Mobile number *

Email address *

Dietary Restrictions - Is there anything your child can not eat and/or drink? Yes / No (If yes, please indicate foods or beverages your child should not consume.) If you have a complex/severe/anaphylaxis allergy please download this policy, complete the form, and email it to mark.mitchell@springwoodbaptist.org.au, https://kiahridge.org.au/wp-content/uploads/2024/03/NEW-Kiah-Ridge-Dietary-Service-Policy-and-Dietary-Service-Request-Form-New-March-2023-1.pdf *

What is your T-Shirt size? *

Medical Condition -Please list any medical conditions or allergies, and any medication or special care they require. If your child is anaphylactic to any substance please provide information regarding EpiPen and management plan * *

Emergency Contact 1 - Please state name and contact number *

Emergency Contact 2 - Please state name and contact number *

I authorise the leader in charge to arrange for my child to receive such first aid and medical treatment as a trained first aid person may deem necessary. *

Yes

I authorise the use of calling an ambulance in an emergency. *

Yes

I accept responsibility for payment of all expenses associated with such treatment. *

Yes

Medicare Number *

I permit photos taken of my child to be displayed in church publications, e.g. website, newsletters, brochures, etc.

Yes

By ticking this box you grant permission for the participant listed above to take part in Springwood Baptist Church ministry activities *

Yes

Date *

2nd Camper from the same family 0

I am a: *

Last Name *

First Name *

Date of Birth *

Email Address *

Mobile Number

School Grade *

Parent/Guardian's name *

Mobile number *

Email address *

Dietary Restrictions - Is there anything your child can not eat and/or drink? Yes / No (If yes, please indicate foods or beverages your child should not consume.) If you have a complex/severe/anaphylaxis allergy please download this policy, complete the form, and email it to mark.mitchell@springwoodbaptist.org.au, https://kiahridge.org.au/wp-content/uploads/2024/03/NEW-Kiah-Ridge-Dietary-Service-Policy-and-Dietary-Service-Request-Form-New-March-2023-1.pdf *

What is your T-Shirt size? *

Medical Condition -Please list any medical conditions or allergies, and any medication or special care they require. If your child is anaphylactic to any substance please provide information regarding EpiPen and management plan * *

Emergency Contact 1 - Please state name and contact number *

Emergency Contact 2 - Please state name and contact number *

I authorise the leader in charge to arrange for my child to receive such first aid and medical treatment as a trained first aid person may deem necessary. *

Yes

I authorise the use of calling an ambulance in an emergency. *

Yes

I accept responsibility for payment of all expenses associated with such treatment. *

Yes

Medicare Number *

I permit photos taken of my child to be displayed in church publications, e.g. website, newsletters, brochures, etc.

Yes

By ticking this box you grant permission for the participant listed above to take part in Springwood Baptist Church ministry activities *

Yes

Date *

3rd Camper from the same family 0

I am a: *

Last Name *

First Name *

Date of Birth *

Email Address *

Mobile Number

School Grade *

Parent/Guardian's name *

Mobile number *

Email address *

Dietary Restrictions - Is there anything your child can not eat and/or drink? Yes / No (If yes, please indicate foods or beverages your child should not consume.) If you have a complex/severe/anaphylaxis allergy please download this policy, complete the form, and email it to mark.mitchell@springwoodbaptist.org.au, https://kiahridge.org.au/wp-content/uploads/2024/03/NEW-Kiah-Ridge-Dietary-Service-Policy-and-Dietary-Service-Request-Form-New-March-2023-1.pdf *

What is your T-Shirt size? *

Medical Condition -Please list any medical conditions or allergies, and any medication or special care they require. If your child is anaphylactic to any substance please provide information regarding EpiPen and management plan * *

Emergency Contact 1 - Please state name and contact number *

Emergency Contact 2 - Please state name and contact number *

I authorise the leader in charge to arrange for my child to receive such first aid and medical treatment as a trained first aid person may deem necessary. *

Yes

I authorise the use of calling an ambulance in an emergency. *

Yes

I accept responsibility for payment of all expenses associated with such treatment. *

Yes

Medicare Number *

I permit photos taken of my child to be displayed in church publications, e.g. website, newsletters, brochures, etc.

Yes

By ticking this box you grant permission for the participant listed above to take part in Springwood Baptist Church ministry activities *

Yes

Date *

4th Camper from the same family 0

I am a: *

Last Name *

First Name *

Date of Birth *

Email Address *

Mobile Number

School Grade *

Parent/Guardian's name *

Mobile number *

Email address *

Dietary Restrictions - Is there anything your child can not eat and/or drink? Yes / No (If yes, please indicate foods or beverages your child should not consume.) If you have a complex/severe/anaphylaxis allergy please download this policy, complete the form, and email it to mark.mitchell@springwoodbaptist.org.au, https://kiahridge.org.au/wp-content/uploads/2024/03/NEW-Kiah-Ridge-Dietary-Service-Policy-and-Dietary-Service-Request-Form-New-March-2023-1.pdf *

What is your T-Shirt size? *

Medical Condition -Please list any medical conditions or allergies, and any medication or special care they require. If your child is anaphylactic to any substance please provide information regarding EpiPen and management plan * *

Emergency Contact 1 - Please state name and contact number *

Emergency Contact 2 - Please state name and contact number *

I authorise the leader in charge to arrange for my child to receive such first aid and medical treatment as a trained first aid person may deem necessary. *

Yes

I authorise the use of calling an ambulance in an emergency. *

Yes

I accept responsibility for payment of all expenses associated with such treatment. *

Yes

Medicare Number *

I permit photos taken of my child to be displayed in church publications, e.g. website, newsletters, brochures, etc.

Yes

By ticking this box you grant permission for the participant listed above to take part in Springwood Baptist Church ministry activities *

Yes

Date *

Leader 0

I am a: *

Last Name *

First Name *

Date of Birth *

Email Address *

Mobile Number

School Grade *

Parent/Guardian's name *

Mobile number *

Email address *

Dietary Restrictions - Is there anything your child can not eat and/or drink? Yes / No (If yes, please indicate foods or beverages your child should not consume.) If you have a complex/severe/anaphylaxis allergy please download this policy, complete the form, and email it to mark.mitchell@springwoodbaptist.org.au, https://kiahridge.org.au/wp-content/uploads/2024/03/NEW-Kiah-Ridge-Dietary-Service-Policy-and-Dietary-Service-Request-Form-New-March-2023-1.pdf *

What is your T-Shirt size? *

Medical Condition -Please list any medical conditions or allergies, and any medication or special care they require. If your child is anaphylactic to any substance please provide information regarding EpiPen and management plan * *

Emergency Contact 1 - Please state name and contact number *

Emergency Contact 2 - Please state name and contact number *

I authorise the leader in charge to arrange for my child to receive such first aid and medical treatment as a trained first aid person may deem necessary. *

Yes

I authorise the use of calling an ambulance in an emergency. *

Yes

I accept responsibility for payment of all expenses associated with such treatment. *

Yes

Medicare Number *

I permit photos taken of my child to be displayed in church publications, e.g. website, newsletters, brochures, etc.

Yes

By ticking this box you grant permission for the participant listed above to take part in Springwood Baptist Church ministry activities *

Yes

Date *

Date & Time

Standard Camper (Purchased after 29th June) 0

2nd Camper from the same family 0

3rd Camper from the same family 0

4th Camper from the same family 0

Leader 0