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My comments

First name

Last name

Phone number

Address

Age

Year at school

Gender

Male
Female

Youth Group / Church

Emergency contact person

Emergency contact phone number

Please detail any relevant medical or dietary requirements

Payment method

Internet banking
Cash

Date of internet banking payment

Our bank account number is displayed below this registration form.

Amount to pay

$100.00

Code

If you have a promo code please enter it below.

Parent/Guardian

I give permission for my son/daughter to attend. I give permission for camp leaders to administer and obtain any necessary medical services in the event of injury or illness. I understand that while the camp organisers and leaders are committed to the safety and care of all on camp they cannot be held responsible for any injury, loss or damage occurring in the context of camp. If my child is sent home from camp I will come and collect him/her or arrange other transport.

Parent/Guardian: I agree

Camper

I agree to keep the camp rules and to participate fully to the best of my ability in all activities. I understand that if I do not do this I will be sent home.

Camper: I agree

Photos & videos permission

I give permission for Pukerau Camps to use photos/videos containing myself for promotional purposes on their website or Facebook page.

I agree
I disagree