Defence Communities Mini Sleepover

Parent/Guardian Details:

First name

Last name

Mobile Phone

Address

Defence ID

Participant's details:

Participant 1 (name, date of birth, gender):

Participant 2 (name, date of birth, gender):

Participant 3 (name, date of birth, gender):

Participant 4 (name, date of birth, gender):

Participant 5 (name, date of birth, gender):

Participant 6 (name, date of birth, gender):

Medical Information: YMCA SA works hard to provide safe, supported and enjoyable camps and activities. Please help us to meet this goal by providing us with as much information about medical, health, behavioural and dietary issues or concerns as you can. Our staff are very happy to discuss any additional requirements or support that is needed.

Does any of the listed participants have any allergies and/or dietary requirements?

Yes

If yes, please outline any dietary requirements below.

Does any of the listed participants have any medical conditions or issues that may affect their participation in this activity?

Yes

If yes, please outline any medical conditions below.

Does your family have Private Health Insurance?

Yes

If yes, please give details of the provider, number and expiry date.

Does your family have Ambulance Cover?

Yes

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Email

Additional Comments or Queries

Image Consent

I agree for my families photograph to be taken, acknowledging that it may be reproduced in print and electronic format for YMCA South Australia promotional activities. I understand that I may request in writing for my families photograph no longer be used in future print or electronic media.

Once you have registered, you will be sent an information pack that details everything you need to know about the program!

We look forward to adventuring with you!