KK "King of my heart" camp 2019 • Wesley Congregational Life

Leader/Junior Leader 0

Camper's details

First Name *

Last Name *

Gender *

M

F

Date of Birth *

Home Address *

Home Postcode

Year in school/junior leader/leader *

Tip: Please choose one

(Campers and Junior Leaders only) School name

(Campers only) Name of friend attending

Medicare # *

PRIMARY EMERGENCY CONTACT DETAILS

Name *

Relationship with camper

Contact # *

Email address *

SECOND EMERGENCY CONTACT DETAILS

Name

Relationship with camper

Contact #

Email address

Leader and Junior Leader Only

All fields must be completed before your registration can be confirmed.

Email address

Contact number

WWCC #

Tip: If you are over 18 years, you must fill this in

(Junior leader only) DIGJC Leader's name

(Junior leader only) DIGJC Leader's contact number

Transport

There is a coach available ONE WAY FROM CROSSLANDS YOUTH & CONVENTION CENTRE TO PRINCES STREET, BESIDE RYDE PARK on Monday 30 Sept. If you would like to leave camp by coach please tick the box below. There is an extra cost of $9.

(Please note: spaces on the coach are limited and will be allocated on a first come first served basis)

I need to be on the coach *

YES

NO

Tip: This will be $9/person

Payment

Details for Direct Deposit

Wesley Congregational Life

BSB: 062 000

Account: 15022487

Reference: 1113CAMP (attendee’s name)

I'm paying by *

Name on card

Credit card number

Expiry date

I give permission for my child(ren) to attend Kingdom Kids Camp 2019 at Crosslands Youth & Convention Centre. I understand that Wesley Mission Staff and Volunteers will take all reasonable care and Wesley Mission will not be responsible for any loss or damage to property or injury. I give my permission for medical/ambulance assistance to be used in case of emergency and agree to pay any costs that may be incurred. I also give permission for my child to be videoed/photographed while at camp for the purpose of a short video presentation which will be made to highlight the events at camp. *

I agree

Parent/Guardian's Full Name *

Date

Leader/junior leader + coach 0

Camper's details

First Name *

Last Name *

Gender *

M

F

Date of Birth *

Home Address *

Home Postcode

Year in school/junior leader/leader *

Tip: Please choose one

(Campers and Junior Leaders only) School name

(Campers only) Name of friend attending

Medicare # *

PRIMARY EMERGENCY CONTACT DETAILS

Name *

Relationship with camper

Contact # *

Email address *

SECOND EMERGENCY CONTACT DETAILS

Name

Relationship with camper

Contact #

Email address

Leader and Junior Leader Only

All fields must be completed before your registration can be confirmed.

Email address

Contact number

WWCC #

Tip: If you are over 18 years, you must fill this in

(Junior leader only) DIGJC Leader's name

(Junior leader only) DIGJC Leader's contact number

Transport

There is a coach available ONE WAY FROM CROSSLANDS YOUTH & CONVENTION CENTRE TO PRINCES STREET, BESIDE RYDE PARK on Monday 30 Sept. If you would like to leave camp by coach please tick the box below. There is an extra cost of $9.

(Please note: spaces on the coach are limited and will be allocated on a first come first served basis)

I need to be on the coach *

YES

NO

Tip: This will be $9/person

Payment

Details for Direct Deposit

Wesley Congregational Life

BSB: 062 000

Account: 15022487

Reference: 1113CAMP (attendee’s name)

I'm paying by *

Name on card

Credit card number

Expiry date

I give permission for my child(ren) to attend Kingdom Kids Camp 2019 at Crosslands Youth & Convention Centre. I understand that Wesley Mission Staff and Volunteers will take all reasonable care and Wesley Mission will not be responsible for any loss or damage to property or injury. I give my permission for medical/ambulance assistance to be used in case of emergency and agree to pay any costs that may be incurred. I also give permission for my child to be videoed/photographed while at camp for the purpose of a short video presentation which will be made to highlight the events at camp. *

I agree

Parent/Guardian's Full Name *

Date

Year 3-6 camper 0

Camper's details

First Name *

Last Name *

Gender *

M

F

Date of Birth *

Home Address *

Home Postcode

Year in school/junior leader/leader *

Tip: Please choose one

(Campers and Junior Leaders only) School name

(Campers only) Name of friend attending

Medicare # *

PRIMARY EMERGENCY CONTACT DETAILS

Name *

Relationship with camper

Contact # *

Email address *

SECOND EMERGENCY CONTACT DETAILS

Name

Relationship with camper

Contact #

Email address

Leader and Junior Leader Only

All fields must be completed before your registration can be confirmed.

Email address

Contact number

WWCC #

Tip: If you are over 18 years, you must fill this in

(Junior leader only) DIGJC Leader's name

(Junior leader only) DIGJC Leader's contact number

Transport

There is a coach available ONE WAY FROM CROSSLANDS YOUTH & CONVENTION CENTRE TO PRINCES STREET, BESIDE RYDE PARK on Monday 30 Sept. If you would like to leave camp by coach please tick the box below. There is an extra cost of $9.

(Please note: spaces on the coach are limited and will be allocated on a first come first served basis)

I need to be on the coach *

YES

NO

Tip: This will be $9/person

Payment

Details for Direct Deposit

Wesley Congregational Life

BSB: 062 000

Account: 15022487

Reference: 1113CAMP (attendee’s name)

I'm paying by *

Name on card

Credit card number

Expiry date

I give permission for my child(ren) to attend Kingdom Kids Camp 2019 at Crosslands Youth & Convention Centre. I understand that Wesley Mission Staff and Volunteers will take all reasonable care and Wesley Mission will not be responsible for any loss or damage to property or injury. I give my permission for medical/ambulance assistance to be used in case of emergency and agree to pay any costs that may be incurred. I also give permission for my child to be videoed/photographed while at camp for the purpose of a short video presentation which will be made to highlight the events at camp. *

I agree

Parent/Guardian's Full Name *

Date

Year 3-6 camper + coach 0

Camper's details

First Name *

Last Name *

Gender *

M

F

Date of Birth *

Home Address *

Home Postcode

Year in school/junior leader/leader *

Tip: Please choose one

(Campers and Junior Leaders only) School name

(Campers only) Name of friend attending

Medicare # *

PRIMARY EMERGENCY CONTACT DETAILS

Name *

Relationship with camper

Contact # *

Email address *

SECOND EMERGENCY CONTACT DETAILS

Name

Relationship with camper

Contact #

Email address

Leader and Junior Leader Only

All fields must be completed before your registration can be confirmed.

Email address

Contact number

WWCC #

Tip: If you are over 18 years, you must fill this in

(Junior leader only) DIGJC Leader's name

(Junior leader only) DIGJC Leader's contact number

Transport

There is a coach available ONE WAY FROM CROSSLANDS YOUTH & CONVENTION CENTRE TO PRINCES STREET, BESIDE RYDE PARK on Monday 30 Sept. If you would like to leave camp by coach please tick the box below. There is an extra cost of $9.

(Please note: spaces on the coach are limited and will be allocated on a first come first served basis)

I need to be on the coach *

YES

NO

Tip: This will be $9/person

Payment

Details for Direct Deposit

Wesley Congregational Life

BSB: 062 000

Account: 15022487

Reference: 1113CAMP (attendee’s name)

I'm paying by *

Name on card

Credit card number

Expiry date

I give permission for my child(ren) to attend Kingdom Kids Camp 2019 at Crosslands Youth & Convention Centre. I understand that Wesley Mission Staff and Volunteers will take all reasonable care and Wesley Mission will not be responsible for any loss or damage to property or injury. I give my permission for medical/ambulance assistance to be used in case of emergency and agree to pay any costs that may be incurred. I also give permission for my child to be videoed/photographed while at camp for the purpose of a short video presentation which will be made to highlight the events at camp. *

I agree

Parent/Guardian's Full Name *

Date