2019 Camp Victory Booking Form

First Name & Surname

Birthdate

Address

This address will receive a confirmation email

Phone

Alternate Phone

Gender

Male Female

Camper's Age

School Term

Name of Parent/Carer

Emergency Contact's Phone

Camper's GP

GP's Address

GP's Phone

NHS Number

Medical Conditions/ Allergies/ Dietary Restrictions/ Special Requests

Details of any medication required during the camp (all medication to b labelled correctly and clearly with name and dose needed each day)

Church Name

Pastor's Name

Church Address

Church Phone

Camp Victory maintains standards of Christian conduct. Any camper refusing to abide by the rules is subject to dismissal with no refund. Please tick the box if you agree to abide by rules of Camp Victory.

My Camper will be attending

Name of Parent/Carer

Date

Camp Victory T-Shirt Size

I hereby give my permission for those working in conjunction with the Crown Christian Heritage Trust to use appropriate photographs of my child taken during Camp Victory in its publicity and publication material and to be displayed at the associated chapels, but to not be used for profit in any way

Yes No

I/we will not hold the organization or its sponsors liable in case of sickness, injury, or loss of property. I/we give consent for our child to receive emergency medical treatment if necessary. This consent serves as permission for treatment by any medical facility that Camp Victory and its counsellors deem proper and necessary.

Yes No

If my camper wants to return home prior to the conclusion of Camp Victory, I/we understand the camp is not responsible to provide transport for the camper.

Yes No

Name of Parent/Carer

Crown Christian Heritage Trust is able to provide transport for children to and from Crown Hall for off-site activities during the week of Camp Victory. The following principles will be adhered to: all drivers will be safely recruited and have valid licenses, all vehicles will be roadworthy (i.e. MOT and appropriate insurance), all occupants of the vehicles will wear seat belts at all times. By ticking the box you: give permission for the camper to be transported to and from the off-site camp activities, understand that your camper will be transported to/from the address on this form (Crown Hall) for these activities, consent to the camper receiving emergency medical treatment if necessary.

I hereby confirm that this form and required information in its entirety is true and not false in any way.

Name of Parent/Carer

Date

If claiming the 'Same Household' discount, please name the sibling that previously booked and select the 'Same Household' discount under 'Camp Costs.' *This discount does not apply across Junior and Senior Camp weeks.

Camp Costs

2019 Camp Victory Booking Form

Description

Please Fix the Following