Figtree Anglican Church -- Ignite 2012 Rego

Registrations are still being taken for Ignite. Full payment of $360 is due before camp.

Ignite Camp Registration

Surname:
First Name:
Age:
Sex:	Male Female
School:
Year Level (in 2012):
Postal Address:
Email:
Parent/Guardian Names:
Tel (Home):
Tel (Mob):
Room sharing:	(If possible, I would like my child to share a room with)
Emergency Contact:	(If Parent/Guardian can't be reached)
Emergency Contact Tel (Home):
Emergency Contact Tel (Mob):
Family Doctor:
Tel:
Medicare Number:
Card Ref. No:
Expiry Date:
Insurance Company:
Membership Number:
Date of last Tetanus Booster:
Special needs:	Please list any dietary needs, allergies, behavioural difficulties, medication or other conditions
Legal restriction:	List names of anyone legally restricted from seeing the camper
No photos:	I do NOT give permission for photos taken of my child on camp to be used for promotional materials
Driving?	I would like to drive the child to the campsite myself
Indeminity:	Parent/Guardian must agree to the following terms and conditions: My agreement indicates my willingness to permit my child to participate fully in all activities associated with the camp, including (but not necessarily limited to) those indicated in the promotional material. In the case of medical emergency, I hereby give permission to the Doctor chosen by the Camp Director to secure proper treatment and/or order hospitalisation, injection, anaesthetic, or surgery for my child as named. I understand that every effort will be made to contact me prior to instituting such procedures.
I will be paying by:	Direct Debit Cash/Cheque