Figtree Anglican Church -- W@B Registration

New to Figtree?

W@B Registration

Payment can be made to the front office or via Direct Debit. If money is an issue, hassle Ron or the W@B team. If not, don't hassle anyone. Either way, register!

Surname:
First Name:
Postal Address:
Email Address:
Tel (Home):
Tel (Mobile):
Emergency Contact (Name):
Emergency Contact Tel (Home):
Emergency Contact Tel (Mobile):
Special Needs:	Please list any dietary needs, allergies, behavioural difficulties, medication or other serious illness or condition that we need to know about.
Medicare No:
Card Ref. No:
Expiry Date:
Insurance Company:
Membership No:
Date of last Tetanus Booster:
Photo permission:	I DO NOT agree to photos being taken of me during camp. Video and photos will be taken throughout the camp. Please select if you do NOT give permission for FAC to use your image in further promotional media.