Camp Clayton

Quick Links

You can now fill in your Leaders and Support Staff registration form Online before any camp! What a time saver!

Please complete this form in full with as much information as possible.

Personal Details:

Name:
Address:
DOB:
Age:
Gender:	Male Female Married Couple We will be bringing our Children
Church Attending:
Home Phone:
Your Mobile:
Email:
Emergency Contact Details:
Emergency Contact:
Home Number:
Their Mobile:
Work Number:
Relationship:
T-Shirt Orders:
	Would you like to buy a 2007 Camp T-shirt? Yes: No:
Please indicate your size/s:	Adult: S M L XL XXL Children: 8 10 12 14 T-shirts cost $15 each, please bring your money to camp to pay on arrival.
Swimming Details:
For your safety and our knowledge, are you a: Non swimmer Fair swimmer Good swimmer For assisting with supervision, do you have a bronze medallion? Yes: No: If you are willing to assist with the supervision of swimming, please supply a copy of your certificate with this form, and list the expiry dates here on the certificate that applies to you Surf certificate: Expiry date: Pool certificate: Expiry date:
Leadership Training Manual: I have received a copy of the Leadership Training Manual (edition 2), and have read and understood it. I agree to work within it’s framework. Yes: No, please send me one:
Dietary Information:
Special Diets:

Medical Information:
Please list any allergies and provide further details. Pollens Medications Foods Insect Bites Other Allergy treatment:
Do you suffer from, or have ever experienced: asthma (severity): epilepsy/seizure disorder heart trouble diabetes physical handicap frequently upset stomach headaches/migraines other
Date of your last tetanus shot:
Do you wear:	glasses contact lenses
Please list and explain any major illnesses that you have experienced during the last year:
Medicare number:
Expiry date:
Paracetamol Permission - parent/guardian to sign if under 18: It is Camp Clayton policy that no medications are administered by Camp staff or leaders without prior arrangement with parents at registration (ie medications provided by parents as necessary for current conditions) or as advised by medical staff on consultation. The only exception to this is paracetamol which may only be administered with the following written consent. Please download this form and bring it to camp with you.

Permission to Print: Please tick if you give permission for camp Clayton to use your photo in advertisements: Yes No
Comments:
If you have any comments or anything you need to let us know that was not included on this form, please let us know here.

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For a free brochure, email us on admin@campclayton.org.au
and provide your mailing address.

Camp Clayton - 41 Clayton Road,
PO Box 3184, Ulverstone Tasmania 7315

Website Design by Tamara Grey