Fusion Leader Rego Camp 2024

Family Name *

Parents/Carer First Name *

Parent/Carer Mobile Number *

Parent/Carer Email *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Medicare Number *

Who are you registering? *

Multiple Options can be chosen

I understand that the balance will be payable via 8 weekly direct debit payment

A link will be sent to you to allow you to setup the weekly direct debits for the balance payable

Details of Attendees (paying deposit or FA)

First Child
Second Child
Third Child
Leader

Multiple Options can be chosen

Child 1 Name *

Child 1 D.O.B *

Does Child 1 have any known allergies? *

Yes
No

Child 1 Allergen Details

Does Child 1 have any dietary requirements? *

Yes
No

Child 1 Dietary Requirement Details

Child 1 Swimming Ability

Unable to swim
Weak Swimmer (fear of water, able to tread water and basic stroke)
Average Swimmer (able to swim more than 100m)
Strong Swimmer (confident to swim more than 200m fully clothed)

Child 2 Name *

Child 2 D.O.B *

Does Child 2 have any known allergies? *

Yes
No

Child 2 Allergen Details

Does Child 2 have any dietary requirements? *

Yes
No

Child 2 Dietary Requirement Details

Child 2 Swimming Ability

Unable to swim
Weak Swimmer (fear of water, able to tread water and basic stroke)
Average Swimmer (able to swim more than 100m)
Strong Swimmer (confident to swim more than 200m fully clothed)

Child 3 Name *

Child 3 D.O.B *

Does Child 3 have any known allergies? *

Yes
No

Child 3 Allergen Details

Does Child 3 have any dietary requirements? *

Yes
No

Child 3 Dietary Requirement Details

Child 3 Swimming Ability

Unable to swim
Weak Swimmer (fear of water, able to tread water and basic stroke)
Average Swimmer (able to swim more than 100m)
Strong Swimmer (confident to swim more than 200m fully clothed)

Leaders Name *

Does the leader have any known allergies? *

Yes
No

Leader Allergen Details

Does the leader have any dietary requirements? *

Yes
No

Leader Dietary Requirement Details

Leader Swimming Ability

Unable to swim
Weak Swimmer (fear of water, able to tread water and basic stroke)
Average Swimmer (able to swim more than 100m)
Strong Swimmer (confident to swim more than 200m fully clothed)

Permissions *

I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand that every effort will be made to contact me prior to instituting such procedures.
During the course of the weekend if your child's behaviour is a detriment to the camp or wider community or they bring prohibited items to camp (alcohol, illicit drugs, weapons), they may be excluded from key parts of the program and/or you will be called to come and pick them up early.
During the course of the weekend, I am aware that my child may be captured on photograph or video which may be used by MEC for promotional or historical purposes.
By checking this box you authorise that the above information is true and your intentions around permissions are clear.

Total

$0.00

Stripe Credit Card *

Card

Name on Card

Questions or Comments

Contact

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