Senior camp enrolment form 2023 First name of student* Last name of student* Date of birth* DD slash MM slash YYYY Emergency Contact #1 Name* Emergency Contact #1 Phone Number*Emergency Contact #2 Name* Emergency Contact #2 Phone Number*Best Contact Email* Do you agree to pay camp fees of $440 per student?*YesNoWould you be willing to donate an additional $40 to contribute to epic camp merchandise? (No pressure)YesNot this timeWould you like to book a place on a coach (with seatbelts) for the journey to and from the TOPS conference centre?YesNoPrice will be determined based on number of passengers (approx $40 per person)Do you require linen at an additional cost of $16 per person?YesNoDoes the student have any medical issues or injuries? Asthma Epilepsy Anaphylaxis Injury Other If yes, please describe below:Does the student have any allergies? Pollen Dust mites Plants (incl. trees/grass) Nuts Gluten Dairy Egg Chlorine Insect stings Other If yes, please describe reaction and treatment required below:Does the student require any medications to be administered while on camp?*YesNoPlease note: all medication will be stored securely and administered by a teacher or parent helperIf yes, please describe below:Does the student have any dietary requirements?*YesNoIf yes, please describe below:Is the student afraid of heights?*NoYesHas the student spent more than a night away from home before?*YesNoN/AAny other special instructions?In the case of an emergency, do you give permission for our teachers to call 000, and perform first aid if the situation requires it, and agree to incur the costs of that service?YesNo