Young Life East Auckland
PO Box 39796 Howick Manukau
eastauckland@younglife.org.nz
095343868
www.younglife.org.nz

Fish Camp 2010 Rego

PLEASE NOTE: AFTER FILLING IN THIS YOU WILL NEED TO DOWNLOAD, COMPLETE AND SEND IN A CAMP HEALTH AND SAFTEY FORM, THERE IS A LINK TO DOWNLOAD THIS SAFTEY FROM IN THE CONSENT SECTION OF THIS ONLINE REGISTRATION PAGE. THIS SAFTEY FORM MUST BE FILLED IN IN ORGER FOR YOUR SON TO ATTEND CAMP.

Student Details

First Name *

Last Name *

Street Address *

Suburb *

City *

Age *

Date of birth : Day *

Month *

Year *

Year at School *

Name of School/Training Institution

Phone Number *

Mobile Number

Name of Young Life Leader - if applicable

Email Address - email addresses will not be shared with other parties *

Please email me about future events

Parent/ Guardian Details

First Name *

Last Name *

Street Address *

Suburb *

City *

Phone Number *

Work Number

Mobile Number

Email Address *

Please email me updates about Young Life's involvement in the community - note no email address will be shared with other parties

Once you have registered we will contact you to confirm your registration and check if there are any queries you have about camp. What is your preferred method of contact? (note we prefer email if possible) *

Post

Home Phone

Medical and Dietary Requirements

Doctors Name

Doctors Phone Number

Please outline any medical conditions, or food/drug/plant/insect allergies that your teenager has.

Please outline any dietary requirements your teenager has

Please contact me to further discuss my teenager's medical needs *

Gear Items

Click here to download the Fish Camp Info Brochure

An extensive list of items that you need to bring to camp can be found on the Young Life Webiste on the Fish Camp page called Fish Camp Info Brochure (you can also find it by clicking on the link above).

Please indicate if you will be bringing your own fishing rod and or tent , otherwise we will provide one for you.

Please note that we due to saftey requirements we prefer that you do not bring your own firearms to this camp

I will bring my own tent

Number of people I'm happy to share my tent with.

I wll bring my own fishing rod

Student Contract

I will take genuine responsibility for my own safety and that of others.
I agree to show respect to others, to follow instructions of Young Life staff and volunteers.
I will declare medical conditions that could effect me.
I understand that my parents/caregivers will be contacted and I may be sent home at thier expense if my actions put me or others in any danger or I am found with illegal drugs or alcohol.
Young Life and associated youth communities have my permission to use any sound or visual recordings of me, without compensation or approval rights, in thier future promotional materials *

I consent to the above

Parental/Guardian Consent

I consent to my teenager’s participation on this Young Life camp. I understand that there are risks associated with any camp and that these risks cannot be com-pletely eliminated. I understand that the leadership will identify risks or hazards and implement procedures to minimise those hazards. I recognise that participation in such activities is voluntary and not mandatory. I agree to my teenager receiving emergency medical treatment if necessary. Any medical costs incurred will be paid by me. If my teenager is involved in a serious disciplinary problem, including the use of illegal drugs or alcohol, or actions that threaten the safety of others, she/he will be sent home at my expense. I understand that Young Life does not accept responsibility for loss or damage to personal property. *

I give my consent to the above

Shooting Consent

Thanks for filling in this consent portion! We also require you to fill in a more detailed health and consent form called "Camp Health and Safety Form" . You can download this from our webiste or by clicking the link below. Once filled in please post to Young Life New Zealand PO Box 39796 Howick Manukau

Download Young Life Camp Health and Saftey Form

I give my son permission to participate in any supervised shooting activities on this camp *

Payment Details

I'll send a cheque (Send to Young Life Po Box 39796 Howick Manukau

I've paid with online banking ANZ 010170007211100 (Ref: ‘Surname’, Code: ‘Fish Camp’)

Payment Amount (Deposit is $25 (non refundable) Full amount $150) *

Payment Date of electronic banking

Other payment information 🛈

Money should never be the reason why a student can't come to camp. With the gernerous support of others in the community we are able to provide camp scholarships. Please let us know if you require help payiing camp fees by checking this box and we will contact you.

I require some financial assistance to pay for camp

Support Options

Young Life's work in the community is funded by people who believe in what we do. If you would like to help support our work then please select the appropriate box below and we will be in contact with you.

I'd like to help fund another student to get to camp

I'd like to make a donation to Young Life (one off or regular)

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