• Camp - Registration Form

    To be filled out by legal parent/guardian if individual is under 18.
  • Start Date*
     - -
  • End Date
     - -
  • Find out more about this camp at pindarilife.org/kidscamp

  • Participant Information

    The following information is regarding the individual attending camp unless specified
  • You are applying on behalf of a Camper/Junior Leader. If this is incorrect and you wish to apply as a Team Member/Senior Leader please change the selection above, titled "Position Registering For"

  • You are applying as a Team Member/Senior Leader. If this is incorrect and you wish to apply on behalf of a Camper/Junior Leader please change the selection above, titled "Position Registering For"

  • You are applying on behalf of your child who is too young to attend as a camper. If this is incorrect and you wish to apply on behalf of a Camper/Junior Leader please change the selection above, titled "Position Registering For"

  • Date of Birth*
     - -
  • Gender*
  • Currently Attending a Youth Group Or Church?
  • Emergency Contact Information

  • Format: (00) 0000-0000.
  • Format: 0000-000-000.
  • Format: (00) 0000-0000.
  • Format: 0000-000-000.
  • Format: (00) 0000-0000.
  • Format: 0000-000-000.
  • Important Information

  • Permission to administer Paracetamol if needed?*
  • Permission to administer Ibuprofen if needed?*
  • Permission to administer antihistamine if needed?*
  • Are you/your child allowed to go swimming*
  • Please grade swimming ability*
  • Do you/your child have any allergies?*
  • Please list any allergies that you/your child haveand mark whether they are MILD (don't need medical treatment), MODERATE (needs medical treatment but not life threatening), SEVERE* (Life threatening), OR ANAPHYLACTIC*(needs an epi-pen and is life threatening)

    If your you/child have more than one allergy please press the "Add Allergy Info" button to fill out multiple allergies.

    *Please email a Management Plan to events@pindarilife.org

  • Meals are provided with the nutrition of the majority in mind, and do not allow for special dietary requirements. Participants with special diets will need to bring their own foods to supplement what is made available by PRIOR ARRANGEMENT ONLY.

  • Any Special Diets?*
  • Please list any Physical Disabilities
  • Please list any Behavioural Conditions (i.e. Afraid of the dark)
  • Please email a Behavioural Management Plan to events@pindarilife.org if necessary

  • Just a quick note regarding support workers; due to the nature of child related camps and events all support workers must be approved by Pindari Life. To ensure support workers meet our standard of care we have partnered with "The Journey Community - Youth & Disability Support Services" (https://www.thejourneycommunity.com.au/) to provide approved support workers.

  • Does child need a support worker?*
  • Behavioural Clause

    To ensure camp is a fun and safe experience for everyone we expect you/your child to abide by the following conditions;
    • Participants must follow staff/leaders directions
    • Respect self and others
    • No current infectious illnesses (such as the vomiting bug)
    • No alcohol or drugs
    • No bullying
    • No verbal or physical abuse
    • No history of child related offences
    • No current allegations regarding any offences

    If you need to contact us regarding any of these conditions you can do so by emailing events@pindarilife.org or phoning 1300 050 228.

  • *
  • Medication to be taken?*
  • Medication Administration Consent and Medication Chart

    Instructions:

    1. All prescription and non-prescription medications shall be clearly labelled with the participants name and date of birth.
    2. Prescription and non-prescription medications will be in original bottle/packaging. It is the parent/caregiver's responsibility to ensure the correct medication and amount of medication is provided on the campers arrival for the duration of the participants stay the event.
    3. Prescription and non-prescription medications will be administered in accordance with label directions.
    4. The number of pills/amount of medication arriving with participant prior to arriving to the event will be clearly stated on the below table.
    5. Signed consent must be provided by the parent/caregiver, permitting the Camp nurse and/or authorized team leaders to administer medications to the participant. Instructions shall not conflict with the prescription label or product label directions.

    Please enter mills or number of pills required in dosage amount section and amount of medication prior to arrival section.

    To add more than one medication please click the "Add Medication Information" button.

  • Disclaimer, Conditions, and Activity Waiver

    Liability Disclaimer – I understand that whilst all care is taken, Pindari Life’ staff, team, and management do not accept liability or responsibility for loss or damage to personal property and/or personal injury/illness arising from the use of the facilities.

    First Aid – I understand that as this camp is an adventure camp which may involve bush walking, camp fires, and outdoor activities, there is a chance that I/my child will need basic First Aid. I understand that all Pindari Life activity staff are First Aid qualified and there is a designated nurse to take care of First Aid and medications.

    I understand that in the event of an injury, Pindari Life will provide any necessary medical treatment, including calling an ambulance. Should this be necessary, I understand that I will be notified as soon as possible. Treatment may be at my expense.

    I agree to indemnify Pindari Life along with all related and affected parties against all claims arising from any injury that may occur relating to myself/my child, along with any loss or damage to property and equipment, arising either directly or indirectly from any connection to the Pindari Life camp.

    Program - I understand that activities are subject to weather and safety assessments at all times. Should an activity be removed from the program, Pindari Life will provide an alternate activity. Adventure activities do have a level of managed risk. Participants are required to follow instructors’ directions at all times. I understand that the program is based on Christian values, and that Pindari Life promotes wise choices, fair play, self-control, and respect of self & others.

    Behaviour Code – Verbal or physical abuse of self or others will not be tolerated. No alcohol or drug use is permitted on site. Actions, practices or behaviour inconsistent with Christian values will not be accepted. Should I/my child refuse to adhere to the behavior code, I understand that they will be expected to leave the site, at my cost.

    Meals – Ration style meals are provided with the nutrition of the majority in mind, and do not allow for special dietary requirements. Should I/my child have a dietary need, I/they will need to bring my/their own foods to supplement what is made available.

    Media - Pindari Life reserves the right to take photos and videos of people and property to be used for promotional purposes. I understand that should I/my child be subject to restricted media access, I will notify Pindari Life, so that I/they can be excluded. Notifications can be emailed to events@pindarilife.org

    Payments – I understand that for camper/junior leader registration, a deposit must be paid to complete registration, and that the total balance must be paid at least 1 week prior to arrival.

    A second invoice may be issued after departure to cover any damages and/or medical treatment and/or other costs related to myself/my child

    Cancellation – I understand that due to the nature of events, and the costs incurred, not the entire fee can be refunded. Cancellations must be a written request to cancel. Cancellations outside of 4 weeks before the event is a $25 cancellation fee, cancellations between 4 weeks and 1 week before the event will incur a $50 fee plus any processing fees. Cancellations within 1 week will incur up to 85% fee In all cases, this is at the discretion of management, further subsidies may be applied.

    Transportation - I give permission for Pindari Life to transport the participant for the duration of the event. I understand that while Pindari Life takes care in transportation incidents can happen and I release Pindari Life from liability in connection with the travel. I also understand that the participant must follow all rules and you must take full responsibility for any fines or expenses due to the participant breaking the rules.

     

    WAIVER OF LIABILITY 

    All participants 18 years and older are required to complete an individual waiver of liability. Participants under 18 years are required to have a parent/guardian or responsible adult sign their individual waiver on their behalf.

     

    Pindari Adventures uses industry standard Risk Management Systems for all programmed activities. Whilst all care is taken there remains a level of risk that varies across the activity types. Participants are required to sign an individual waiver of liability to confirm that

    1.      They accept that there are potentially dangerous activities that could result in injury;

    2.      They accept the risks involved and are responsible for their own actions and/or involvement;

    3.      They are under no obligation to participate or complete the activities if they have concerns about their ability to do so;

    4.      If anything is unclear in the briefing prior to an activity that they will raise their concerns with a team member conducting the briefing;

    5.      To the best of their knowledge they are physically able to participate in the activities and know of no reason as to why they should not.

  • Date of agreement*
     - -
  • Need financial assistance?
  • Need financial assistance?

    Some options and suggestions include:

    1. Check with your local church to see if they're happy to sponsor you for camp.

    2. Check with other organisations; some community organisations have funds available for respite care i.e. NDIS, local Lions Club, RSL.

    3. Apply for our Breakaway Fund: https://jotform.com/250647594058062

  • Enter REGIONAL into the subsidy code to get your $55 regional discount.

  • Volunteering as a Team Member? Enter PLTEAM as the subsidy code to remove the camp fees!

  • *

    prevnext( X )
      Camp Fees
      $540.00 AUD$540.00AUD
        
      Total
      $0.00 AUD$0.00AUD

      Card

    • Should be Empty: