SPRING HOLIDAY CAMP REGISTRATION FORM

Please complete a seperate form for every child you wish to register.

Parent/Guardian Details

Adventurer's Details

Indigenous Status  

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.

This is the 10 digit number that appears on your card.
This is the number listed next to your child's name on your medicare card.
Ambulance Cover  
Does your child have ambulance cover?
Does your child have any dietary requirements?  
Does your child have any allergies?  
Do your child identify as having a disability or special need?  
Will your child need to be administered medication while in our care?  
We ask that you clearly label the medication and supply to staff.
Does your child have any conditions or issues that may affect your participation in this activity?  
Have you been to the hospital in the last 3 months?  

Please email any relevant documentation to sayouth@ymca.org.au on completion of this application.

Further Details

Please include name, name of organisation, address and email
How would you like to pay?  
Payment must be made at least 2 weeks before the event.
Please provide any comments or information regarding the drop off and collection of your child.

Image Consent

I agree that:

  1. Photographs may be taken of my family, acknowledging that it may be reproduced in print and electronic format for the Young Men's Christian Association of South Australia Inc. or YMCA South Australia Youth and Family Services Inc. (collectively, ‘YMCA South Australia’) promotional activities. I understand that I may request in writing for my families photograph to no longer be used in future print or electronic media.
  2. The YMCA South Australia may use audio recording, video images, and/or photographs of me, or other information about me (‘Content’) in any of its publications or materials for any lawful purpose (including but not limited to promotion and marketing, reporting, public relations, and fundraising).
  3. The Content may be used in various media formats, including online media, social media, print, newspaper, video, multimedia, public displays, television and electronic means of communication and in any edited form.
  4. I will waive any rights and claims, present and future, to any fees or royalties or other benefits whatsoever for or in connection with the use of the Content. For the avoidance of doubt, I agree that I will receive no payment for the use or recording of the Content by YMCA South Australia.
  5. I release YMCA South Australia from any loss, damage, cost, expense, or claim arising out of the use of the Content, including any action for defamation, libellous material, breach of privacy, or copyright.
  6. If I wish to withdraw permission for the Content to be used, I must so inform YMCA South Australia in writing. I understand that if I so withdraw consent for the Content to be used, YMCA South Australia will cease any future new publication or use of the Content, but for several years the Content may appear in printed and electronic material which has already been produced or disseminated.

Once you have registered, you will be sent further details everything you need to know about the program!

Payment

Once you have submitted the form you are welcome to pay the fee by credit card by calling 8298 7422. Alternatively, we can email you an invoice. Payment must be made at least 2 weeks before the event.

We look forward to adventuring with you!