Registration

Please complete the form below (required fields are marked *) 

If you do not recieve a reply within 2 days please contact us to make sure we have recieved your registration.

**UPDATE 4th October (8am)… To meet current Delta level 2 restrictions we have had to close registrations as we have reached our limit of campers.  If you are keen to come please still register as there may be spots come available closer to the time.

Registration Form

Registration type*

 Camper

 Leader/VIP

Name*

Email*

Address*

Phone*

Year at School

Age*

Gender*

 Male

 Female

Youth Group / Church

Emergency Contact Person*

Emergency Contact Number*

Please detail any relevant medical or dietary requirements

Payment Method*

 Cash

 Internet Banking

If paying by Internet Banking, date of payment

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.

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.

I Agree

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

Please type the letters from the image above*