Youth Camp Application

Garden Route Youth Camp 2020 Application & Indemnity Form

* Indicates required field

Name of Camper *

First

Last

Date of Birth *

ID Number *

Male/Female *

T-Shirt Size *

The following information is essential in case of medical treatment or hospitalization (if the answer is "none" or "not applicable" indicate as such):

Medical Aid Fund (if applicable) *

Known Medical Conditions *

Membership Number *

Dietary Requirements/Allergies *

If applicable, my child takes the following medications and has brought them to camp: *

Parent/Guardian Name *

First

Last

WhatsApp # *

Work Phone *

Email *

Home Address *

Please chose one of the following *

I will arrange transportation for my child to and from the camp My child will need to be picked up and dropped off at the above home address

If you child needs a Bible, please select child's preferred language: *

English Afrikaans Xhosa My child will bring their own Bible

Emergency Contact Name *

First

Last

WhatsApp # *

1. I, the parent/guardian of the above camper, hereby give permission for him/her to participate in the Garden Route Youth Camp from 23 March – 28 March, 2020 and the activities conducted in association with the camp, and to travel to and from in any transportation provided. I understand that the staff will act in the best interest of my child and I fully understand and accept that participating in the camp will be undertaken at my child’s own risk and I undertake on behalf of myself/my executors, my spouse and my child aforesaid, to indemnify, absolve and hold blameless Knysna Hope and Beyond the Moon and all other persons and organizsations associated with the camp against and from all claims whatsoever that may arise in connection with the loss of, or damage to the property, or injury to the person of my child aforesaid in the course of the camp.

2. I consent to an appointed first aid officer giving basic first aid care if required.

3. I accept that all reasonable precautions will be taken to ensure the safety and welfare of my child and that I shall be held responsible for the payment of medical and/or hospital accounts, where applicable, should any injury be sustained which cannot be ascribed to negligence on the part of the staff responsible.

4. I understand that should my child be found in possession of alcohol, tobacco, drugs, firearms, or knives at any time during the duration of the camp, they will be subject to dismissal. Transportation from the camp will be at my expense.

5. I consent and understand that videos and photographs of the campers may be taken during the camp by Knysna Hope staff and that these videos and photographs may be used to promote both the camp and Knysna Hope via social media and the Knysna Hope website.

6. As far as I know my child is in good health.

7. I understand that Knysna Hope staff will check for head lice at the start of camp and will treat appropriately.

8. I consent to allowing the following medications given to my child at the discretion of Knysna Hope First Aid personnel: Panado for pain, Diphenhydramine for severe allergies.

9. A deposit of R200 is due at the time of registration, with the balance of R600 due on/before drop-off. Funds can be deposited into the Knysna Hope bank account: FNB Branch Code 250655, Account number 62594087639.

I agree/disagree to the above *

I agree I disagree

Parent/Guardian Name *

First

Last

Parent/Guardian ID Number *

Submit